SMDA was hired by a Michigan family to compel an insurance company to pay Long Term Care benefits for their elderly mother who had been receiving care at a Long Term Care facility. The family had purchased an insurance policy to help defray the cost of care for their mother who had developed a number of age related medical problems including Alzheimer’s. The insurer initially agreed to pay the daily benefit but changed course rejecting the claim alleging that their mother no longer met the policy requirements because it claimed she was capable of performing most of her activities of daily living unassisted.
After reviewing the medical records from her doctors and the long term care facility SMDA filed suit against the Insurer for its breach of the insurance contract. As a result of the litigation, the Long Term Care Insurer agreed to pay all of the past due benefits as well as refund the premiums that were paid after the wrongful denial of benefits. Regular readers of this blog will recognize this as a bit of an outlier as it is not a claim for Long Term Disability Insurance nor does it involve the ERISA statute. However, we were happy to help this family obtain the Insurance benefits that they had paid for and that will allow their mother to continue to receive the quality of care she needs in her time of need. If you have a claim for Long Term Care benefits that you believe was wrongfully denied or terminated, please feel free to give SMDA a call to discuss.