State RegulationsNY specificDifficulty 2/5
An insured holds an individual disability income policy from one insurer and a separate indemnity policy from a different insurer, both paying benefits for the same loss, and this insurer was not given written notice of the other coverage before the loss. Under the other benefits provision required by N.Y. Ins. Law §3216(d)(2)(E), what must this insurer do?
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Answer & full 3-part explanation (select an option above, or peek)
Why C is correct
Under N.Y. Ins. Law §3216(d)(2)(E), if there is other valid coverage, not with this insurer, providing benefits for the same loss on other than an expense-incurred basis, the insurer's only liability is for a proportion of the indemnities otherwise provided, based on the like indemnities of which the insurer had notice compared with the total of all like indemnities, together with the return of the premium that exceeds the pro-rata share. The insured recovers a fair share rather than a duplicate windfall, and any overcharge is refunded.
Why the other options are wrong
- A) Having a second insurer does not entitle the insured to duplicate full benefits; the provision limits recovery to a proportionate share.
- B) Other coverage does not void the claim; the insurer still pays, but only its proportionate share of the indemnities.
- D) The provision governs indemnity benefits rather than expense-incurred reimbursement, which is handled by coordination rules for expense benefits.
Memory hook
Duplicate indemnity coverage: proportionate share plus a premium refund.