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Long-Term Care Insurer Sued for Not Providing Benefits

Ensuring that resources will be available to provide day to day caregiving during one’s golden years is one of the main reasons local residents visit a New York elder law attorney. To accomplish that goal we often explain how tools like long-term care insurance and a Medicaid Asset Protection Trust (MAPT) can be used in combination. The insurance provides actual payments so that seniors can have at-home care when necessary. The MAPT does not provide resources, but it protects some assets that the individual already has from potential long-term care costs in the future.

Because the insurance both protects assets and provides resources, long-term care insurance is generally the superior method of protection. However, long-term care insurance can be expensive, particularly when it is sought by one who is already reaching on in years or is in poor health. The earlier that this insurance is sought the more likely that it will be within one’s financial reach.

When a client visits a New York elder law lawyer in our office, we share information about these insurance options. We appreciate that residents want to feel comfortable with their insurance providers–insurance companies are not thought of highly by some residents. Horror stories abound of individuals who dutifully paid premiums only to have difficulty receiving the help they needed. One benefit of having legal professionals involved in the process is the extra set of eyes that will be watching the senior’s finances, ensuring that they are not taken advantage of by anyone, including insurance companies.

Unfortunately, this extra protection is sometimes needed. For example, just last week the L.A. Times discussed a new lawsuit filed by a consumer watchdog group against a long-term care insurance provider–Senior Health Insurance Co. of Pennsylvania. The suit alleges that the company engaged in a range of tactics and schemes to avoid paying claims for potentially thousands of seniors.

The consumer group suggests the company ignored or took unreasonably long periods of time to respond to claim requests. They further allege that the insurance company required unnecessary paperwork and medical examinations. In other cases the company is accused of having required caregivers to have certain licenses, even though that violated company policy. One plaintiff, a 78-year old former doctor, apparently purchased the insurance eighteen years ago. However, the company refused to honor 80% of the claims requests that he submitted.

Long-term care insurance remains a very prudent option for many families. However, it only works when the insurance provider acts fairly and appropriately. Be sure to get in touch with a legal professional whenever you have concerns about your long-term care insurance or planning.

See Our Related Blog Posts:

Long-Term Care Insurance is Key Medicaid Strategy to Protect Assets

Do Not Let Long-Term Care Destroy Your Retirement Planning

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