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COAN v. STATE FARM MUT. AUTO. INS. CO.
January 13, 1996
SHAWN COAN, Plaintiff,
STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY.
The opinion of the court was delivered by: SPATT
This case arises from a dispute as to whether the defendant, State Farm Mutual Automobile Insurance Company, ("State Farm" or the "defendant") must provide disability insurance benefits to the plaintiff, Shawn Coan ("Coan" or the "plaintiff") after the defendant elected not to renew the plaintiff's policy in accordance with New York state law. Both parties now move for summary judgment as the underlying facts are not in dispute.
The plaintiff, Shawn Coan, is a resident of Suffolk County. The defendant, State Farm, is an Illinois Corporation licensed to sell health insurance in the State of New York. On October 3, 1990, the defendant issued to the plaintiff an insurance policy characterized as a "Limited Benefit Hospital-Surgical Policy" under Policy Number H7175390 3232 (the "Policy").
The Policy provides for $ 1,000,000 in benefits coverage with a $ 250 deductible for health and medical expenses including disability related charges. The Policy furnishes 80 percent coverage for the first $ 8,000 in expenses and 100 percent coverage for remaining costs for the balance of the calendar year.
The Policy defines Total Disability or Totally Disabled as the complete incapacity of the Covered Person as the result of an Injury or Sickness:
1. to perform the substantial or material duties of any occupation for pay or profit, or if not employed, to engage in the normal activities of a person of the same age; and
2. which requires the regular care of a Physician other than a Covered Person.
However, "any refusal to renew the policy shall be without prejudice to any claim originating while the policy is in force. Such action shall not affect any claim for expenses incurred: (1) while [the] policy is in force; or (2) during a period of time when benefits are extended subject to the Extension and Limitation of Coverage provision."
An "Extension and Limitation of Coverage" may occur in the following circumstances:
If a Covered Person is Totally Disabled on his/her coverage termination date benefits provided for that Covered Person by this policy and any attached riders will be extended:
1. for the injury or Sickness which caused the Total Disability;
2. during the uninterrupted continuance of the Total Disability; and
3. during the twelve months following the Covered Person's coverage termination date.
During the extended coverage the applicable policy and rider provisions, exclusions, exceptions and limitations will be the same as would have applied had ...
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