DI Law Group was hired to assist a 91 year old woman in obtaining the home health care benefits to which she was entitled under her long term care policy with Genworth Insurance Company. After months and months of providing Genworth with information, medical records, and physician forms clearly detailing her inability to safely dress, transfer, and bathe without either hands-on or standby assistance, she and her son became extremely frustrated and reached out to our firm. Our client, a widow who I will refer to as Mrs. X, procured a long term care and home health care policy over 25 years ago and timely paid her premiums every year because she felt it was important not to have to burden her children physically and financially should the day come that she could no longer take care of herself. About 2 years ago, Mrs. X began to experience some memory issues, balance problems, and overall weakness. However, she took great pride in being extremely independent and was extremely reluctant to admit that she needed assistance. As a result, her son (who is in his 60s) became very worried and felt it necessary to spend more time with her to make sure that she did not fall and could get to her doctor appointments. Unfortunately, her health continued to decline and after her 3rd or 4th fall he convinced him mom to apply for home health care benefits under her Genworth Long Term Care plan.
Mrs. X and her son worked diligently to get Genworth the medical records, doctor statements, Plan of Care, and other information needed to confirm her eligibility for these benefits. Despite the fact that this 91 year -old woman had already fallen several times, Genworth continued to seek additional information and clarification about her memory issues to see if she qualified for benefits under the cognitive portion of the policy. While her memory had certainly declined and she needed reminding about which medications to take at what time or where she left something, it was never alleged that she required nursing assistance due to dementia. However, Genworth used this as a reason to delay a decision in this matter and avoid paying benefits.
As soon as DI Law Group got involved, we reviewed what had already been submitted, got additional statements from her physicians, wrote a detailed letter summarizing her medical records, limitations and why she required assistance with at least two Activities of Daily Living, and demanding immediate payment under the terms of the Policy. We received a call the next day from the Genworth representative who explained that she had been confused by some of the information in the medical records, but with my letter which summarized the medical conditions and explained why Mrs. X could not safely bathe, transfer or dress without some form of assistance, they agree that benefits were due. We, of course, had to resubmit the invoices that showed payments made to the home health care agency thus far and reminded Genworth that they also needed to reimburse Mrs. X for all premiums paid since the date she became eligible for benefits almost 6 months ago.
Unfortunately, many long term care insurance companies take advantage of insureds that are ill or elderly and do not have the physical and/or mental stamina to deal with their unfair, and often unconscionable, delay tactics. Long term care benefits are quite often a life-saving necessity for many people and unfair delays can cause unwarranted and severe financial, emotional and physical stress on the insured and their family. If you or a loved one have questions about a long term care policy, are currently seeking benefits, or have been unfairly denied benefits, please feel free to contact us for a free consultation. Our website is www.dialwgroup.com and our toll free telephone number is (866) 363-3628.