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Nick DiCello
Nick DiCello
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Faced With More Claims, Long-term Care Insurers Deny Benefits

9 comments

As Baby Boomers aged, there was a boom in the sale of long-term care insurance during the 1990’s. Now, however, an ever increasing portion of our population, which is living longer and longer, is seeking protection under their long-term care policies. One insurance company executive described the situation as follows: “The long-term care party of the 1990s gave us one hell of a hangover in the 2000’s.”

Long-term care insurance is a contract or policy of insurance which promises, in exchange for the timely payment of premiums, coverage for expenses of long-term care, such as the costs of a nursing home or assisted living facility. As more and more Americans with long-term care insurance enter these facilities, the insurance industry is faced with making good on their promises. Some insurers, however, have miscalculated the profitability of certain long-term care insurance products. For example, many insurers fighting to get into the “long-term care party of the 1990s” overestimated policy lapse rates and miscalculated the mortality rates for the target population. Now, during the “hangover,” insurers too commonly attempt to refuse payment of legitimate claims, sometimes on a global scale.

On March 15, 2006, Penn Treaty President and CEO issued a news release indicating that a “review is showing us that our policyholders remaining on claim beyond three years (particularly on policies issued prior to 2002) appear to be living longer than we had previously anticipated, which will likely cause us to pay higher future benefits due to the expanded duration of these claims.”

Denial of a long-term care claim or the loss of one’s long-term care coverage can be devastating. Imagine becoming accustom to life in a long-term care facility only to one day receive a letter from your long-term care insurer stating that it is “no longer medically necessary” that you or a loved one continue to receive nursing home care, and that benefits will end. This is a common exclusion cited by long-term care insurers to deny benefits. Without benefits, the elderly individual must tap into his or her assets to continue to pay for care, or must burden their family for assistance. Ultimately, once one’s assets are exhausted, he or she is forced to seek government assistance.

If you or a loved one has had their claims for long-term care benefits denied or their policy rescinded, contact the trial attorneys at Spangenberg, Shibley & Liber, LLP for a consultation, and protect your legal rights.

9 Comments

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  1. Stephen Forman says:
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    Mr. DiCello, I know you are just trying to drum up some business with this post, but really? Which LTC insurers are denying “legitimate” claims “globally”? “Medical necessity” is a trigger in Non-TQ policies, not an exclusion. What was the point of the PTNA non sequitur? The CEO was citing a landmark Milliman study which the entire industry has relied upon (and may now inform current efforts to reform our country’s healthcare system no matter which form it takes). Last year, private LTC carriers paid out a record $8.5 Billion in claims– they are delivering on their promises. I believe in the need to protect policyholders’ rights, but we needn’t introduce hyperbole. Thank you.

  2. William Hoffman says:
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    Now 9 days after my broken left arm, I still am being evaluated by incompetent Genworth Care Scout Evaluators! Genworth says for me to now spend my money for my care and if Genworth qualifies me, Genworth will pay me-maybe!

    Policyholders of Genworth Long Term Care BEWARE!

    We are no different than Hurricane Katrina Victims!

    We pay very expensive premiums for oftentimes many years for LTC from Genworth, formerly GE LTC- who “twisted” the GE LTC policyholders int0 Genworth, and when now that we are elderly and cannot be eligible for any other LTC insurance other then Genworth- we are stuck & denied LTC by Genworth’s burdensome & copious amounts of confusing & manipulatie paperwork!

    I am forming a RICO Class Action Complaint with the SEC and the US Attorney!

    Genworth and GE are “THE MADOFF’s” of LTC! They take billions of dollars from trusting USA now elderly defenseless people! We have scrimped and saved to pay Genworth’s premiums- which are literally a Madoff Ponzi Scheme!

    Contact to join this Genworth RICO Class Action for defrauding thousands of elderly USA Citizens their rights for dignified LTC in their Senior Years of life that remains- now without real LTC benefits!

    Review your LTC needs & beware of the mistruths & fraudulent claims of Genworth LTC!
    upsidebill@gmail.com

    William Hoffman, Baltimore, MD

  3. Jesse Slome says:
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    One never wins friends with pithy comments but a broken arm likely doesn’t qualify as a long-term care condition and that’s what this protection is for. I suspect you can still eat, go to the bathroom, walk and get dressed even if it’s not as comfortable as it was before you broke your arm.

    I also suspect that you may have purchased a policy with a deductible period (typically called the Elimination Period). That reduced the cost of your insurance policy significantly. But, it also means that a policy won’t kick in (assuming you qualify as being incapable of performing two Activities of Daily Living) until the deductible period is met.

    There is a lot of misinformation about long-term care insurance and one can’t blame attorneys for capitalizing on that.

    But insurers pay claims. Indeed many go well beyond the requirements of the law and the States that regulate these policies. Frivolous lawsuits and threats of RICO action just increase the costs of protection for everyone.

    Hope your arm heals and that you never need your long-term care insurance policy. When you are 2 ADL disabled, it will make a broken arm seem like a sore throat. At that time, I suspect you’ll be very glad you have the protection in place.

  4. Matthew Perry, LTCP, CLTC says:
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    What a load of crap. I recognize that my comments are not as eloquent a those of Mr. Foreman and Mr. Slome, but I believe they are accurate. After reading this article (i.e. advertisement) all I wanted to do was take a shower.

  5. william hoffman says:
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    Genworth Falls After Citigroup

    By Andrew Frye

    Aug. 14 (Bloomberg) — Genworth Financial Inc., the life insurer and mortgage guarantor that reported five straight quarterly losses, fell in New York trading after Citigroup Inc. recommended clients sell the company’s stock.

    Genworth dropped 47 cents, or 5.4 percent, to $8.28 at 4:01 p.m. in New York Stock Exchange composite trading. The Richmond, Virginia-based insurer, which has more than doubled this year as its investments improve, is still down 47 percent over the last 12 months.

    Genworth’s twin businesses have weighed on results as the real estate slump pushed up claims in the home-loan protection unit, and the 12-month decline in stocks hurt life insurance returns. Chief Executive Officer Michael Fraizer has cut 1,000 jobs and canceled the dividend to preserve capital.

    “Things will likely get worse before they get better,” Colin Devine, an analyst with Citigroup, said yesterday in a research note. “We believe management continues to pursue a fundamentally flawed strategy of trying to combine a mortgage insurance business with a traditional life and annuity writer.”

    Devine downgraded his rating on Genworth to “sell” from “hold.”

    To contact the reporter on this story: Andrew Frye in New York at afrye@bloomberg.net.
    Last Updated: August 14, 2009 16:11 EDT

    Print

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  6. William Hoffman says:
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    To Mr. Slome, Mr. Foreman, et al-
    This was just the tip of the iceberg!
    My sister Audrey and her husband Jack Burg ages 72 and 82 have been jerked around since June, 2009, with broken ribs, sciatic and related crippling ADL! Genworth denied them both! And no- I paid extra premiums for 1st day coverage still being evaluated! I hope you never break a limb, but if you do live alone- like me- try to shower, bathe, and perform ADL’s for yourself!

    This is not a meals on wheels charity! We have paid expensive premiums for now many years!

    GE was great! Genworth has flunked and is perpetrating at best malfeasances of services and at worst RICO activities! Which are conspiratorial!

    Call me!I will discuss this further!

    443-527-6330!

    Bill Hoffman

  7. Jeff Flanzer says:
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    Mr. Hoffman. There is a difference between going on claim and the elimination period. What you need to go on claim is a statement from your doctor that you will need assitance with 2 ADL’s for at least 90 days. Your elimination period, whether 0 days or longer, begins its countdown when the 90 days or care is anticipated and documented by your doctor. Does your doctor think you’ll need 90 days of care for your broken arm?

  8. William Hoffman says:
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    Mr. Flanzer! I am judging Genworth both by the written words in their GE LTC polcy & their deeds and actions! I recently spoke with Genworth’s Pres. Stinson complaint line’s rep. Gail Cleary! 1-800-888-6183. She further told me that as is now planned for me to have my knee replacement operation
    that I first have to have my knee operation and then and only then will I be evaluated by Genworth
    and not to be professionally pre-planned! Which prior to Genworth, GE LTC was notified of my right foot surgery! My Dr Miller wrote a recovery plan and I met with the LTC Care coordinator! When my foot surgery was done, GE had their LTC care givers in-place! Now- no way no-how! I will be in pain & recuperation trying to have Genworth evaluate my needs for many days first!No different
    then what is now happening to my sister Audrey and her husband Jack, 72 & 82! Suffering everyday since their filing for benefits from Genworth since June, 2009- now in Aug 20, 2009- denied after their spending the hours to file Dr forms, care giver reports, and taking treatmemts for their permanent and not temporary ADL’s! They have appealed the Genworth denial, which could now take many months more to win or lose! But, just as the Author Nick DiCello, Esq. states-“..the elderly taps into their own assets until they are broke…! Of course most likely defaulting on the Genworth premiums and letting Genworth off-the hook! Since- instead of their premium being waived during their approved disability? They have to their $6,000.+ premium or lose it! There’s the catch-22! Genworth’s Ponzi Scheme to now be the #2 LTC Company- collecting over $15billion in premium per year and pay little back- is the Maddoff Scheme of promises to trusting policyholders, but pay very little and thwart claimants from timely receiving their LTC! With Genworth- instead of the best years to come as insured LTC- now will be the worst years to come!

    I have pet insurance for my 13 year old Lhaza dog Corky! I paid premiums todate from when she was born, May, 1996, to VIP Pet Insurance! Now VIP Pet Ins. is paying for the care my dog needs!

    I have AFLAC, and they are helping me and paying with no problems!

    Genworth is doing what they want to thwart claimants their eligible claims!

    Bloomberg News Reporter Andrew Frye’s Google listed article 0f Feb 10, 2009 and recent interviews on Aug 14, 2009-
    “Things {Genworth} will likely get worse before they get better!” Michael Frazier, CEO Genworth has cut 1,000 jobs…! So? Who or how will Genworth give services cutting 1,000+ jobs?

    What does bode for the policyholders of Genworth LTC- the second largest LTC Company? They are collecting $15billion, but spending per Andrew Frye Aug 14, 2009, pursuing a fundamentally flawed strategy…!

    I understand that maybe Warren Buffett is looking at Genworth!? As a satisfied GEICO Auto Policyholder for many years- maybe that’s what Genworth needs? Warren Buffett’s’ TLC and brilliance on how to handle insureds needs!

    Try to call Genworth after hours or a Saturday or a Sunday! 1-800-456-7766
    Just a message to call back with no voice-mail to leave an important messaage! Try LTC JOHN HANCOCK OR METROPOLITAN, ETC! THEY ALL HAVE NIGHT AND WEEKEND EMERGENCY LINES! BUT NOT GENWORTH- EVEN AFTER I SUGGESTED TO PRES. STINSON’S VOICEMAIL HOTLINE- 1-800-888-6183!

    WHEN IS IT TIME TO INVESTIGATE GENWORTH? BEFORE OR AFTER YOUR LTC NEEDS?

    REMEMBER FOR WHOM THE BELL TOLLS! IT TOLLS FOR US ALL- TO BE AWARE NOW!

    AM I THE ENEMY OF GENWORTH? Or just a concerned policyholder for myself, my friends that I put into GE LTC and for the many other Genworth policyholders! If you have read
    Ibsen’s Enemy of The People! Who is the Enemy? I am sounding the alarm!

    SINCERELY,
    BILL HOFFMAN

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    I think these comments, and the article by Mr. DiCello are at the heart of what is wrong with inurance in this country. Mr. Hoofman is trying to get treatment. The insurance company is barraging him with gobbledy gook. The comments from the professional insurance folks – I do not question their accuracy or sincerity – are complex and confusing. I do take issue with accusations that the author, Nick DiCello is just trying to get business. DiCello’s article has obviously exposed a controversial part of LTC insurance and in so doing he has made a public service for those of us who pay big premiums for protection. I hope he makes some money so he can continue speaking up for consumers in Ohio. As the heat of the responses indicates, you risk a lot whenb you stand up to the insurance industry. Look at what these monstrous corporatuions are doing to keep their lock on the government and their trillions of dollars to stop Single payer and the Public Plan in national health care. The y fight dirty. Lucky we have guys like Nick DiCello to stand up to them.