Long Term Care Issues-Can A Long Term Care Isurance Policy Be Reinstated if the Insured Forgets to Pay the Premium?

As people begin to age and have difficulties managing their affairs, they may forget to pay their Long Term Care Insurance premiums. I have seen this happen many times to individuals. This is a potentially devastating loss of critically important insurance coverage for obvious reasons. First, they have paid premiums for many years only to find that now when the benefits are needed, the need is the thing that caused the lapse. Second, because of age and infirmity, this valuable coverage is no longer available. Finally, because of the exorbitant cost of care, losing insurance coverage will create a huge financial strain.

Florida law recognizes this "catch 22". The law provides that if the insured person allowed the lapse to occur unintentionally due to a medical condition that prevented the payment of the premiums, the policy can be reinstated. Also, the law requires the insurer to advise the insured that premium and other important notices be sent, upon request, to a secondary addressee.

We have assisted many people in getting their policies reinstated. If you or a family member have suffered the lapse of a Long Term Care Policy, you may qualify for reinstatement. We can help. Call us at 305-868-1400.

Long Term Care Issues- Are Assisted Living Facilities Covered Under Home Care Policies?

In my 5 plus years of handling Long Term Care Insurance claims, I have seen several issues cropping up on a regular basis. The first issue I dealt with of course, was my father's case in which John Hancock Insurance Company refused to cover the cost of care my father received in an Assisted Living Facility (ALF). Since that time, we have been successful in many cases against several insurance companies on the same issue-whether a "home care" policy, should cover the cost of care in an Assisted Living Facility.

We have had this issue with Washington National Insurance Company, Bankers Life Insurance Company, Senior Health Insurance Company of Pennsylvania (SHIP), Guarantee Trust Life Insurance Company, Genworth, Transamerica, and others.

We believe there is no good reason under the law for a long term care insurer to deny such a claim. Under Florida law, an ALF is a person's home and when a person enters an ALF because he or she requires assistance with activities of daily living, so long as the care the person receives is documented and delivered pursuant to a plan of care, then the care should be covered.

It seems as though the push back from the insurance companies is rooted in the desire to see that a percentage of its insureds never receive long term care benefits; and if they can successfully assert that ALFS are not covered, then they have succeeded in taking premium dollars from their insureds and avoid paying them benefits when they need them, the goal of which is to line their own pockets.

We are determined to fight this fight. Recently, in Storfer v. Guarantee Trust Life Insurance Company (GTLI), the Federal Court for the Southern District of Florida ruled in favor of the insured who by necessity entered an assisted living facility. Needless to say GTLI Company denied the claim and actually argued that by interpreting the policy in such a way as to deny the claim, it was actually doing its insureds a favor! That argument was rejected by the court. True to its philosophy of denying needed benefits to its insured, GTLI has appealed the decision. Click the following link to view the court decision: http://longtermcarelawoffice.com/wp-content/uploads/10-18-10-Storfer-Order-Granting-Summary2.pdf

If you have a long term care insurance policy, are living or in an ALF, or are contemplating moving into one, we can help you. Contact us at 305-868-1400.

Sydelle Ruderman, et al v. Washington National Insurance Company-Class Action Case

It has been quite a while since I last posted a coment about this case. Indeed much has happened in the past 2 years.

First, we reached a partial settlement with Washington National involving the people whose benefits had been cut-off and were forced to go out of pocket for their care. Perhaps the most significant part of the settlement was our ability to pursuade the insurance company to put all of those people back on claim immediately and keep others on claim, who during the pendency of the case, were soon to reach either their occurrence maximum of $150,000 or lifetime maximum of $250,000. This aspect of the settlement not only provided immediate relief to people who had been paying huge sums of money for their care, but also assuaged those who would soon be in the same position. Needless to say, the feedback we received from the many people who we represented was overwhelmingly positive for which we are extremely gratified.

Second, we were able to agree through tough negotiations, that Washington National would put up 8 million dollars to satisfiy the claims of those people who went out of pocket after their benefits were cut-off. Also, we were able to agree to a streamlined claims process and limited the proof our clients would be required to submit in order to receive reimbursement.

Finally, although we tried very hard to negotiate a settlement regarding the amount of benefits available to the policyholders going forward, ultimately those negotiations broke down. Consequently, we brought a motion to the court asking for a judgment finding that all of the policy benefits should have been growing at a compounded rate of 8% per year from the date the policies were purchased. The court agreed and entered judgment accordingly. Effectively, because of the average age of the insureds, the policies will pay benefits for the rest of the insureds' lives. That judgment is on appeal in the 11th Federal Circuit Court of Appeals. The insureds will remain on claim during the pendency of the appeal, and regardless of the outcome, the insureds will no be required to pay any of the money back.

It has been estimated that the full value this case brought to the insureds is in excess of 30 million dollars.