April 15, 2012

Insurance Company Refuses to Pay for Nursing Home Care, Held Accountable by Court

by Levin & Perconti

The Illinois nursing home neglect lawyer at our firm appreciate that seniors and their families face so many pressures on a consistent basis to ensure financial, medical, and mental well-being. Rising healthcare costs, senior service cuts, and other challenges hit older Americans hard. The recent downturn was particularly tough for those who saw retirement saving slashed through no fault of their own. Amid all of these concerns, even those seniors who planned ahead and have insurance policies in place to provide support at these times are sometimes forced to go to court to get the basic support to which they are entitled.

For example, the Huffington Post shared a story this week on the story of one woman who had to fight her insurance company to get her nursing home stay covered. This sort of insurance claim denial of seniors is an underhanded form of elder abuse that must be guarded against.

In this case, the 90-year old woman explained how she and her late husband bought long-term care insurance in 1997 to cover medical and living expenses in their twilight years. The woman dutifully paid premiums for a decade on the plan. About five years ago the woman’s health deteriorated. She was diagnosed with Alzheimer’s and moved into an assisted living facility in 2008.

Amazingly, for no apparent reason, the insurance company cut off the woman’s coverage after two years. The woman was forced to go several years with no insurance support. The company eventually agreed to continue coverage but refused to reimburse the woman for the care that they didn’t pay for the few years in the middle. The family eventually sued the insurance company and recently won the case. In a unanimous jury verdict, the jury found that the company breached its contract with the woman. The jury did not buy the company claim after the fact that they felt that the senior did not actually need the care that she was receiving. They ordered the company to pay over $34 million for their egregious conduct—however that figure will be cut down substantially because of arbitrary caps on putative damages in the state.

Finding the right nursing home is hard enough. Each Chicago nursing home abuse lawyer knows that the process is made even more excruciating when families have to fight insurance companies for their unscrupulous conduct just to have the resources that are owed to provide for long-term care. It is important for local families to know that they do not have to engage in these battles alone. The law demands that seniors in these situations receive fair, reasonable, and honest treatment. If that treatment has not been provided, families should not hesitate to visit with local elder care lawyers or other professionals to ensure that their rights are respected.

Unfortunately, many big interests, including nursing home chains and insurance companies, do not respond to anything but legal force. It is easy for individual families to get intimidated. Don’t let that happen in your case. Seek out legal help today and fight back.

See Our Related Blog Posts:

Consumer Voice Launches New Guide to Help With Long-Term Care Decisions

October Declared Nursing Home Residents’ Rights Month