Insurance Company Sued for Denying Elderly & Sick Their Home Care Benefits
Santa Monica, CA –Senior Health Insurance Company of Pennsylvania (SHIP) is refusing to honor thousands of long-term care insurance policies it sold to Californians, leaving the elderly and infirm without the care they need, according to a lawsuit filed today by lawyers for Consumer Watchdog and Shernoff, Bidart Echeverria Bentley LLP.
The suit charges that SHIP – which services policies that were originally sold by Conseco, American Travelers Life, Transport Life, United General Life, and Continental Life Insurance Company – is telling policyholders who file claims under their long-term care policies that caregivers who come to their home must be licensed when in fact licensing is not required. According to the suit, the company is also requiring policyholders to produce extensive documentation not required by the policy and requiring policyholders to undergo unnecessary medical examinations by personnel selected by SHIP. Examples of SHIP’s abusive documentation practices aimed at denying coverage include requiring multiple claim forms requesting duplicate information, forms authorizing SHIP to obtain medical records, proof of caregiver certification, and detailed daily caregiver notes.
The plaintiff in the lawsuit, Dr. William Hall of Upland, California, a former U.S Army colonel who earned a Purple Heart in the Korean War and the former Chief of Medicine at a California hospital, is 87.
“My Dad bought this policy to spare his children some of the time and expenses that many of our parents require when they get older, but SHIP has only drained my family’s resources,” said Dr. Hall’s son, Eric Hall. “Because of SHIP, my family has spent more time and expense on his care than if he had never bought the policy in the first place. It has been an uphill battle.”
“SHIP’s claim process not only violates California law, it violates the terms of the insurance policy that it sold to Dr. Hall,” said attorney William Shernoff of Shernoff Bidart Echeverria Bentley, who represents Dr. Hall. “Dr. Hall bought his policy in 1994. He paid the premiums on it promptly for 16 years. But when he finally needed the care he was entitled to, SHIP delayed his claims for eight months, and even then paid only 20% of what SHIP owed Dr. Hall. As a result, he was forced to spend over tens of thousands of dollars to pay home caregivers out of his own pocket, exhausting his family resources, and his children stepped in to take care of him – exactly the circumstances Dr. Hall sought to avoid by purchasing the coverage from the company 18 years ago.”
"SHIP is preying on society’s most vulnerable. From the moment SHIP receives a claim for benefits, SHIP inundates its elderly policyholders with indecipherable correspondence, fictitious requirements, and needless demands for irrelevant information,” said Harvey Rosenfield, founder of Consumer Watchdog and counsel for Dr. Hall. “These ailing seniors simply cannot contend with SHIP, and their families are left worrying about how to pay for the care their loved ones need."
Download a fact sheet about the lawsuit at: http://www.consumerwatchdog.org/resources/shipfactsheet.pdf.
Download the complaint filed in San Bernardino Superior Court here: http://www.consumerwatchdog.org/resources/hallfiledsc2-7-12.pdf.
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