Disability Insurance Claim Articles

Noteworthy California Disability Insurance Decision Regarding The Regulatory Duties Of
Departments Of Insurance / Insurance Commissioners

There once was a California disability claimant named Cassaundra Ellena whose Standard Insurance Company disability claim was denied as a result of the policy’s “any occupation” / “own occupation” language.¹ Eventually, Ms. Ellena took issue with the California Department of Insurance regarding such language.

In short, Ms. Ellena alleged that the “any occupation” / “own occupation” language contained in her Standard disability insurance policy was overly restrictive and that the California Department of Insurance did not, pursuant to the California Insurance Code, review such language before Standard issued policies in California containing such language.

To make a long story short, the California appellate court held, in part, as follows:

We conclude that the Insurance Code requires that the commissioner review a disability policy form prior to approving the policy. The trial court therefore erred in finding that Ellena failed to state a claim for mandamus against the DOI based on her allegations that the commissioner did not review the policy to ensure that it complies with California law prior to approving the policy for distribution in California.

Ellena v. Dept. of Ins., 178 Cal. Rptr. 3d 435, 449-450 (Cal. App. 1 Dist. 2014) (footnote omitted).

So, to all the departments of insurance / insurance commissioners out there who are subject to codes similar or identical to the California Insurance Code at issue in Ellena, it would behoove you to review insurance policy language that you let infiltrate your state. That task is an important one, as it is designed to ensure that consumers are not harmed by insurance contracts that contravene state law.

To all the disability insurance consumers out there (or any insurance consumer, for that matter), do not count on your state’s insurance code affording protections similar or identical to those afforded in the California Insurance Code and do not count on your department of insurance / insurance commissioner doing their job; i.e., reviewing insurance policy language to ensure it comports with state law. Be careful, among other things, about the “any occupation” / “own occupation” language contained in your prospective disability insurance policy – in my opinion, you want air tight “own occupation” language making up the policy’s “disability” definition, even if it means paying a bit more premium.

Disability Insurance Claim Articles