N.Y. Comp. Codes R. & Regs. tit. 11 § 220.2

Current through Register Vol. 46, No. 50, December 11, 2024

Section 220.2 - Standards for diligent and expeditious investigation of claims

(a) Any insurer organized, registered, licensed, or accredited to do an insurance business in New York State shall diligently and expeditiously investigate any claim arising from an occurrence during the period between January 1, 1929 and December 31, 1945 which is made by an individual that the insurer knows, or reasonably should have known, is a Holocaust victim as defined in section 2701 (a) of the Insurance Law.

(b) All claims by Holocaust victims and all available evidence relating thereto shall be reviewed by an insurer in a diligent and expeditious manner in accordance with the standards of proof described in section 220.3 of this Part. In reviewing claims, an insurer shall give due consideration to any facts which tend to establish the bona fides of the claim, including in particular any circumstances which indicate that the person is a Holocaust victim as defined in section 2701 (a) of the Insurance Law. The review process to be established by the insurer shall include, but not be limited to, the following actions:

(1) Holocaust claims unit. The insurer shall establish a Holocaust claims unit staffed with personnel fully familiar with the standards of proof described in section 220.3 of this Part.

(2) Contact person and inquiries. The insurer shall designate a named contact person to handle inquiries related to Holocaust victim claims. The contact person's name and telephone number shall be made a part of the annual filing with the superintendent required by section 2705 of the Insurance Law and section 220.5(e) of this Part. The contact person shall be fully familiar with the standards of proof described in section 220.3 of this Part. In responding to any inquiry by a claimant or other party, the contact person shall inform the person making the inquiry of the existence of the New York State Holocaust Claims Processing Office and shall provide the then current toll-free telephone number of such office. The providing of such information shall be in addition to and not in substitution for any other action required to be taken by the insurer.

(3) Research of policies issued. In order to facilitate matching of Holocaust victim claims with insurer records, each insurer shall diligently research its records related to insurance policies as defined in section 2701 (c) of the Insurance Law which were issued through December 31, 1945. Based on this research, the insurer shall compile the following information regarding policies issued to Holocaust victims that remain unpaid or were paid to or expropriated or seized by a government located in an area that was or had been under Nazi influence that was not the named beneficiary of such insurance policy:

--Type of policy- life, accident and health, annuities, property, casualty, education, dowry, or other;

--Insured name or names;

--Policy owner's name or names, if applicable;

--Policy beneficiary's name or names, if applicable;

--Policy effective dates and issue dates;

--Policy limits, face amount or pay-out value;

--Whether a claim was made to the insurer; name of claimant or claimants;

--Whether a claim was denied; if denied, date and reason for denial;

--Claims paid arising from an occurrence during the period between January 1, 1929 and December 31, 1945;

--Dates any claims were paid;

--Names of payee or payees;

--Whether a claim, surrender value, benefits or proceeds under the policy were paid to a government located in an area that was or had been under Nazi influence, and if so, in what manner;

--Whether a claim, surrender value, benefits or proceeds under the policy were expropriated or seized by a government located in an area that was or had been under Nazi influence, and if so, in what manner;

--Whether attempts were made by the insurer to locate the beneficiaries of any such insurance policies for which no claim of benefits has been made.

(4) Research of abandoned, expropriated or seized property. To further aid Holocaust victims in their rightful recovery of insurance proceeds, each insurer shall also research its records for evidence of assets or funds turned over to various jurisdictions as abandoned, expropriated or seized property, to locate any such information relevant to policies issued to Holocaust victims. The insurer shall compile the same categories of information as required by paragraph (3) of this subdivision, to the extent applicable, together with the identity of the jurisdiction to which the assets or funds were turned over, the date the assets or funds were turned over, and the value thereof. Such information shall be submitted to the superintendent upon request.

(5) Expeditious treatment of claims.

(i) Insurance claims of Holocaust victims shall be treated in an expeditious manner pursuant to the standards set forth in this paragraph. The provisions of Part 216 (Regulation 64) of this Title shall not apply to such claims.

(ii) Each insurer shall establish procedures to commence an investigation of a claim filed by such a claimant, or a claimant's authorized representative, within 15 business days of receipt of notice of the claim. Within 30 business days after receipt by the insurer of a notice of claim and any statements, affidavits or other evidence filed in support of the claim, the insurer shall advise the claimant, or the claimant's authorized representative, in writing, of the acceptance or rejection of the claim by the insurer. If the insurer needs more time to investigate the claim, it shall so notify the claimant, or the claimant's authorized representative, within 30 business days after receipt of the notice of claim and shall request any further necessary statements, affidavits or evidence consistent with the standards set forth in section 220.3 of this Part. Such notification shall include the reason why additional time is needed for investigation. If the claim remains unsettled, unless the matter is in litigation or arbitration, the insurer shall, 90 days from the date of the initial letter setting forth the need for further time to investigate, and every 90 days thereafter, send to the claimant, or the claimant's authorized representative, a letter setting forth the reason why additional time is needed for investigation. In any case where the claim is rejected, the insurer shall notify the claimant, or the claimant's authorized representative, in writing, of its specific reason for rejecting the claim. In any case where there is no dispute as to one or more elements of a claim, payment for such element(s) shall be made notwithstanding the existence of disputes as to other elements of the claim where such payment can be made without prejudice to either party. Any notice rejecting any element of a claim shall contain the following statement prominently set out:

"Should you wish to receive further advice on this matter, you may write to the New York State Holocaust Claims Processing Office, at Two Rector Street, New York, New York 10006."

(6) The provisions of this subdivision shall be deemed to be complied with by an insurer if the insurer is participating in the international commission or successor entity and the criteria set forth in section 220.7 of this Part are being met by the insurer and the international commission or successor entity; and the superintendent has found that the insurer is fully complying with the standards for diligent and expeditious investigation of claims established by such commission or successor entity.

N.Y. Comp. Codes R. & Regs. Tit. 11 § 220.2