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

I am currently handling a class action lawsuit involving a Pioneer Life/Washington National Insurance Company long term care insurance policy. The policy was sold in the early 1990's with a $180 daily maximum benefit, $250,000 lifetime maximum benefit, and a $150,000 per occurrence benefit. Most importantly, the policy was also sold with an 8% benefits increase provision. However, the company failed to apply the 8% increases to the lifetime and per occurrence benefits and has been cutting people off prematurely for years.

The case was filed in the United States District Court for the Southern District of Florida. Recently, the court issued a ruling that will require the company to apply the benefits increase to all of the policy benefits.

Contact me to discuss your policy.

Why We Launched This Blog

This blog is being launched to discuss the issues of long-term care insurance.
The people most affected by long term care insurance problems are the children of elderly parents who have developed the need for assistance with activities of daily living. These activities may include, to name a few, bathing, dressing, feeding, or ambulating. Additionally, the need for assistance may be the result of memory problems that have made independent living a hardship. These life changes are undoubtedly challenging for the family and include the need to make critical decisions such as whether to move parents into assisted living, bring care givers into the home, or perhaps consider a nursing home. All of these options are expensive.

Long-term care insurance is supposed to be there if and when the need arises. All too often, insurance companies deny valid claims at a time when people are most vulnerable. Also, policies may appear not to cover certain things when in fact they do. It is critically important to the proper planning of care that your rights are fully understood before making decisions that you may not be able to undo. One should never take it for granted that an insurance company denial is valid. Remember, insurance companies are in the business of making money, not paying money. Remember, that you or your parents paid hard earned money to buy the insurance that is supposed to be helping at a time of need. KNOW YOUR RIGHTS.

Hopefully, we will be able to offer you some insight into the issues surrounding perhaps the most important insurance policy you own-Long-Term Care Insurance.