New York State Seal
STATE OF NEW YORK
INSURANCE DEPARTMENT
25 BEAVER STREET
NEW YORK, NEW YORK 10004

The Office of General Counsel issued the following informal opinion on October 3, 2000, representing the position of the New York State Insurance Department.

RE: Regulation 64 and Disability Benefits

Question Presented:

Does N.Y. Comp. Codes R. & Regs. tit. 11, § § 216.0-216.12 (1982) (Regulation 64) ("Unfair Claims Settlement Practices and Claim Cost Control Measures") apply to N.Y. Workers’ Comp. Law, Article 9 (McKinney 1994 & Supp. 2000) ("Disability Benefits")?

Conclusion:

N.Y. Comp. Codes R. & Regs. tit. 11, § 216. 2 (1984) (Regulation 64) ("Applicability") precludes some components of Regulation 64 from being applicable to N.Y. Workers’ Comp. Law, Article 9 (McKinney 1994 & Supp. 2000), because disability benefits are encompassed within accident and health insurance policies written pursuant to N.Y. Ins. Law § 1113(a)(3) (McKinney 1985 & Supp. 2000).

Analysis:

N.Y. Ins. Law § 1113(a)(3)(i) (McKinney 1985 & Supp. 2000) states:

(3) "Accident and health insurance," means (i) insurance against death or personal injury by accident or by any specified kind or kinds of accident and insurance against sickness, ailment or bodily injury, including insurance providing disability benefits pursuant to article nine of the workers' compensation law.... (Emphasis added).

N.Y. Comp. Codes R. & Regs. tit. 11, § 216. 2 (1984) (Regulation 64) states in pertinent part:

(b) Subdivision (b) of section 216.6 of this Part shall not be applicable to accident and health policies written pursuant to the provisions of section 1113(a)(3) . . . .

(c) Sections 216.4 and 216.5 and subdivision (c) of section 216.6 of the Part shall not be applicable to policies of accident and health insurance written pursuant to the provisions of section 1113(a)(3) . . . where the claimant is neither a policyholder, a certificate holder under a policy of group insurance, nor a relative or member of the household of such policy or certificate holder.

Accordingly, you are advised to examine those components of Regulation 64 that do not apply to Disability Benefits.

For further information, you may contact Senior Attorney Robert Freedman.