AMICUS AI
Citation Codes
Equivalent Citations
citation codes
Attorney(S)
Judges
Are you a practicing lawyer?
Enhance your digital presence and reach by creating a Casemine profile.
Upload pleading to use the new AI search
Cites
Cited by
Citation Codes
Equivalent Citations
citation codes
Attorney(S)
Judges

CYRIL H. MOORE, JR., on Behalf of Himself and All Other Similarly Situated Employees of the State of New York Who Are Members of the New York State Health Insurance Plan under Major Medical Expense Group Policy 18250-G, Plaintiff, v. METROPOLITAN LIFE INSURANCE COMPANY, Defendant

FRANCIS J. BLOUSTEIN, J.

In this action upon a group health insurance policy it is not contested that plaintiff received treatment from a certified and registered psychologist. Plaintiff seeks reimbursement for this expense upon the basis of section 221 (subd. 5, par. [e]) of the Insurance Law, effective September 1, 1969, as amended July 6, 1971. Plaintiff further contends that the policy, in effect, is renewed each year and thus is modified by said section. The import of the section is that if a policy provides for treatment by a physician for emotional disorders, then registered, certified psychologists are also to be included.

Defendant's contention that its policy, issued in 1957, is one complete policy and thus unaffected by section 221 Ins. of the Insurance Law is rejected. "Where an insurer has the absolute right to terminate a policy on its anniversary date ( Western N Y Med. Plan v. Wikler, 8 A.D.2d 988) * * * each renewal of the policy is deemed the issuance of a new policy" ( Gladstone v. Metropolitan Life Ins. Co., 66 Misc.2d 656, 657).

Furthermore, defendant has failed to exclude specifically reimbursement for emotional or nervous disorders from its definition of illness or injury or covered medical expenses.

Accordingly, plaintiff's motion for summary judgment is granted.

Use AI to get other relevant cases.

Comments

MOORE v. METROPOLITAN LIFE INSURANCE COMPANY
(Aug 21, 1972)