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

George E. Pataki
Governor

Gregory V. Serio
Superintendent

This Office of General Counsel issued the following opinion on June 24, 2004, representing the position of the New York State Insurance Department.

Re: Request to Increase Liability Limit & Insurer’s Request for Medical Statement

Issue:

May an insurer request an insured to complete a medical statement as a precondition to increasing the coverage limit of her umbrella insurance policy?

Conclusion:

The insurer’s request for a completed medical statement is only permissible if the information that the insurer seeks from the insured is relevant to the underwriting risk for which the insured seeks increased umbrella policy coverage.

Facts:

A divorced homemaker has an umbrella policy that provides excess liability coverage over her personal lines automobile and homeowners insurance policies. The insured has asked her authorized insurer to increase her umbrella insurance policy’s coverage limit. Her insurer has responded by requiring the insured to complete a medical statement as a precondition to considering the request.

Analysis:

An authorized insurer may ask an insured for information that is relevant to the underwriting risk for which the insured seeks coverage. Accordingly, an insurer may ask an insured to complete a medical statement if the information that the insurer seeks from the insured is relevant to the underwriting risk for which the insured seeks increased umbrella policy coverage.

Under the facts presented, the insurer has not explained how the insured’s personal medical health is relevant to underwriting an increase in the liability limits of the insured’s umbrella policy, which provides excess liability coverage for the homemaker’s personal lines automobile and homeowners insurance policies. Therefore, the Department recommends that the insured ask the insurer to explain in writing why the insured’s personal medical health is relevant to underwriting such risk. If the insurer fails to respond or does not provide an adequate explanation for requesting the medical statement, the insured should file a complaint with the Consumer Services Bureau of the New York State Insurance Department at:

Consumer Services Bureau
NYS Insurance Department
25 Beaver Street
New York, NY 10004-2319
800-342-3736 or 212-480-6400

For further information you may contact Senior Attorney Kristian Earl Lynch at the New York City Office.