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Long-Term Care Insurance Company Sued For Predatory Business Practices
It’s no secret that in home assistance for elderly near San Diego is expensive. Many people facing their twilight years invest in a long term care insurance (“LTCI”) policy, ensuring that the costs of their medical and non-medical care from caregivers in San Diego County will be covered. This forward-looking action takes a huge burden off family members, both in terms of monetary expense and actual work needed to provide care.
In most cases, long term care insurance companies fulfill their obligations, but a lawsuit in progress against the Senior Health Insurance Company of Pennsylvania (SHIP) illustrates the disastrous results that occur when a company fails to do so.
This case also illustrates the importance of knowing how to file Long-Term Care Insurance claims. We have written many articles about this topic, and about how to avoid LTCI companies’ attempts to delay or even avoid paying legitimate LTCI claims.
Delaying Tactics
Many California residents, foreseeing the need for San Diego County caregivers, have purchased policies from SHIP in order to cover in home assistance for elderly near San Diego. One California man, frustrated by a mountain of unfair requirements, documentation requests, and other stalling tactics, has brought a lawsuit against the company for failure to honor his policy.
According to the lawsuit, SHIP arbitrarily added a large number of requirements that are not included in the original policy’s language, putting up a barrier that has made it impossible for the plaintiff to obtain the care that the policy promised him. Instead of benefiting from the policy, he has had to struggle with the added requirements while paying for necessary care out of pocket in the meantime.
Added Requirements for Coverage In Home Assistance for Elderly Near San Diego
One of the most serious violations of the plaintiff’s insurance policy was a refusal to pay for home care by unlicensed caregivers. There is no stipulation in the original policy that caregivers be licensed, but when the California man submitted information on his care expenses, SHIP refused to pay based on the absence of licensing.
Obviously, it is illegal for an insurance provider to add this licensing requirement after a client has already been paying premiums on a policy. Nonetheless, this is a common delaying tactic, in our experience, when families of LTCI policyholders attempt to file claims on their own without help from in-home care companies.
Predatory Business Practices
Trying to avoid paying for in home assistance for elderly near San Diego is called a predatory business practice in the lawsuit. Because aging individuals already have a hard time filling out forms, submitting documentation, and meeting other requirements for insurance claims, it is unacceptable for a company to add confusing and overwhelming requirements that make it impossible for seniors to benefit from the services they have already paid for. Hopefully, the outcome of the lawsuit will reimburse the expenses of the plaintiff and discourage such unethical practices in the future.
Original article: http://www.sacbee.com/2012/02/08/4249218/consumer-watchdog-insurance-company.html
