Long-term Care Insurer, Policyholder Resolve Lawsuit
A settlement has been reached in a lawsuit by Dr. William Hall against Senior Health Insurance Company of Pennsylvania (SHIP) upon terms that are mutually agreeable to both parties. Patrick Carmody, the General Counsel for SHIP, confirms that an agreement has been reached to resolve all of Dr. Hall’s claims, with all parties compromising and working together.
SHIP provides long-term care policies that cover, among other expenses, the cost of “home care,” which includes services of personal caretakers for in-home assistance with activities like bathing, dressing, eating, using the restroom, and moving about. Such policies are designed to provide seniors who can no longer function independently with the necessary services to enable them to remain living in their homes.
The suit, filed in February 2012, in San Bernardino County, California Superior Court by Dr. William Hall alleged that SHIP did not treat his claims for home care fairly and that some of SHIP’s procedures for handling such claims were unfair and too burdensome, among other things. SHIP countered that Dr. Hall simply did not comply with standard procedures that its other policyholders comply with. Both Dr. Hall and SHIP agreed to work together in the future to ensure all policy holders get the best service and benefits that SHIP has always tried to provide.
SHIP disputed the allegations, but has nevertheless agreed to address some of the issues raised by Dr. Hall by making some changes to its claims handling procedures.
“SHIP wanted to address some of the issues raised by our complaint promptly, and we worked with them to reach a settlement that will help SHIP’s California policyholders, their families, and the company process claims more efficiently,” said William Shernoff, counsel for the plaintiff in the case.
Under the agreement SHIP will:
• Provide policyholders with a new “Frequently Asked Questions Sheet,” or “FAQ Sheet,” containing information as to what SHIP needs to process claims, how to contact SHIP for more information, and how to obtain additional forms;
• Confirm, and clearly inform policyholders that, home care providers need not be licensed in California in order for claims to be paid;
• Simplify the “Daily Visit Notes” forms that home care providers need to fill out as part of a claim for Home Care, and eliminate the weekly form;
• Utilize special procedures for those making a claim for the first time when home care providers did not complete “Daily Visit Notes” for past care and policyholders were not aware of the “Daily Visit Notes” requirement or did not obtain the “Daily Visit Notes” form;
• Accept a letter from a policyholder’s physician as evidence of the start date that a policyholder becomes eligible for benefits;
• Attempt to contact policyholders over the phone when SHIP needs more information to process a claim;
SHIP also resolved claims made by Dr. Hall under his own policy.
“As we urged in our lawsuit and in subsequent discussions with SHIP’s General Counsel and attorneys, SHIP has done the right thing for its policyholders. We understand and appreciate SHIP’s new procedures and all parties are satisfied with this agreement,” concluded Harvey Rosenfield, founder of Consumer Watchdog and counsel for plaintiff in the case.
Tom Lincoln, an attorney representing SHIP, agreed, and added, “I think when two sides work together and are willing to be reasonable, this type of lawsuit can be resolved without litigation.”
A copy of the settlement agreement can be found at: http://www.consumerwatchdog.org/resources/ship_settlement_agreement_website.pdf
Consumer Watchdog is a nonpartisan consumer advocacy organization with offices in Washington, D.C. and Santa Monica, CA. Find us on the web at: http://www.ConsumerWatchdog.org
Shernoff Bidart Echeverria Bentley LLP is the nation’s leading firm for bad faith insurance matters, specializing in the representation of insurance policyholders in the areas of health and disability, HMO, life, homeowner's, automobile, business property, liability, and catastrophic injury insurance. For more information, go to: http://www.shernoff.com
Lincoln, Gustafson and Cercos LLP, is a civil litigation firm that focuses on resolving complex and difficult claims brought by individuals and businesses both before and after they have been sued. For more information, go to: http://www.lgclawoffice.com
SHIP is on the web at: www.shipltc.com
- 30 -
1/5/2016News ReleaseNew Study Shows Too Many Insured Patients Are Not Covered, Rate Regulation Needed to Protect California Policyholders from Crushing Medical DebtSanta Monica, CA – A Kaiser Family Foundation/New York Times survey showing that one-in-five working-age Americans ran into... More >
1/11/2016News ReleaseCA Health Plan Regulators Must Protect Consumers from Unreasonable Rate Hikes in Proposed Aetna-Humana MergerSanta Monica, CA — Consumer Watchdog today urged the Department of Managed Health Care (DMHC) to use its authority over the... More >
1/22/2016News ReleaseConsumer Watchdog Asks Centene, Health Net Execs To Commit To Correct Network Deficiencies, Ensure Fair Rates, Prove Consumers Will Not Pay Merger Costs, At Hearing TodaySacramento, CA -- Consumer Watchdog will challenge executives at a Department of Insurance hearing into the proposed Centene/... More >
3/4/2016News ReleaseDMHC Must Require Consumer Protection Commitments in Anthem-Cigna Merger or Reject Plan If Companies Refuse, Says Consumer WatchdogSanta Monica, CA — Consumer Watchdog today urged the Department of Managed Health Care (DMHC) to require Anthem and Cigna... More >
3/29/2016News ReleaseSan Francisco, CA – Consumer Watchdog today called on Insurance Commissioner Dave Jones to reject a proposed merger of... More >