New York, NY: Insurer John Hancock is facing a bad faith insurance class action lawsuit alleging it failed to pay room and board costs, among other charges, covered under the terms of its long-term care plan. Filed by lead plaintiff Grace L. McElwee, the complaint states that John Hancock Life Insurance Co.' "modus operandi"is to deny coverage to its customers who have already paid for and are receiving room and board from retirement community operators before they were confined to nursing home or assisted care living facilities.
According to the suit, McElwee, who is 89 years old, bought a John Hancock policy in 2002. Then, in 2012, she began to require long-term care. According to the terms of her policy, the company was required to pay out long-term care claims within 100 days after she had filed her claim declaring herself to be in need of "substantial assistance"with everyday activities or cognitively impaired.
However, "John Hancock has refused to pay Grace McElwee for room and board and other nonexempt charges while being confined to both 'nursing home' and 'assisted care' facilities,"the complaint states. McElwee has been confined to a nursing home and assisted care facilities since the effective date of the long-term care coverage, which would have been February 2013, the complaint states.
According to the complaint, McElwee' policy "expressly states" that room-and-board charges constitute a component of nursing home and assisted care living costs. The long-term care coverage exceptions are charges by physicians, hospital and labs, medical supplies and equipment, transportation and items for "beautification, comfort, convenience or entertainment,"the complaint notes.
"Thus, room-and-board costs are not excepted as charges under the policy for either nursing care or custodial care, and those room-and-board charges are therefore compensable under the policy,"the complaint states.
Further, McElwee asserts the insurer wouldn't "account for its denial of claims"that are covered by Medicare, such as the leg injury she incurred last year that required surgery and hospitalization. Additionally, the insurer has failed to provide a written breakdown of charges covered by Medicare, "making it impossible"to determine if McElwee has received the insurance benefits to which she is entitled.
The proposed class, which could possibly include thousands of members, represents any insureds denied coverage for room-and-board costs, claims that are allegedly paid out by Medicare and all or a portion of their right to payment, according to the complaint.
The case is McElwee v. John Hancock Life Insurance, case number 3:15-cv-07398, in U.S. District Court for the District of New Jersey.
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My 92-year old father has had a very similar experience as the commenters. John Hancock Long Term Care Insurance appears to act in very bad faith, trying not to pay claims for one reason or another. The first go-around with them not paying was when they said he was not eligible for long-term care because he was fine on his own. This was not true. At that time, he was 89 and required at least three or four of the indicators for long-term care. After fighting that claim and having an independent assessment done, John Hancock agreed that he needed care. They began paying his claims but did not reimburse him for the claims during the three-month period where he was supposedly able to take care of himself.
Now, they are denying care because they say that the care providers need to be certified. This was not something that they required before - his care providers are all very qualified and have been providing care for many years. As a senior, he has a limited income and cannot afford to continue paying these bills without John Hancock's reimbursement. I have been trying to clear up this situation for weeks after his caregivers tried for over two months. My father bought his policy through IBM in 1990. You can imagine the premiums he has paid during those years, yet John Hancock is nickle and diming him, trying not to pay him a cent. It's a true disgrace.
Posted by Evelyn Laurin
on
We have had long term care policy with John Hancock for over 20 years, Now that one of us tries to file a claim for assistance J. Hancock is requiring that a person providing ADL be certified and the cost of between $600 and $1000 be paid by us or else they will not cover a helper who is not certified. ADL : activities of daily living. Has anyone gone to training to know how to bathe, dress, eat, etc. Has any mother/father received training to be a parent? Or is a way to deny coverage?
Posted by Cecelia G Cosand
on
My mother has been paying for LTC since 2003. She has paid in over 60K over that period of time. Now that she needs it, John Hancock has denied her claim 2x plus an appeal. Their response is always a canned response with no definitive reasoning. We have been in this process for close to a year. My mother is 88 and her health is declining rapidly. I would think they would realize she needs this coverage but apparently they have no soul, no feelings and are motivated by the bottom line. Really a case of fraud.
Posted by Gsdean
on
I total agreed... I feel that I've been and continue to be con out of my money and there is nothing I can do about it. I've had it too long to let it go and they know that. I got my long-term policy almost 20 years ago and now that I'm older they said they have to raise my premium again or I could take a reduce return rate policy for the New amount I'm paying. It's just wrong...WHERE IS THE LEGAL SUPPORT????
Posted by Gerald Beaumont
on
Answering Vicki Youngleman’s post. My wife and I are in the same boat as you with the past, current and future premium increases we are advised will come on our J H long term care policies. We, too, will be priced out of the policies we have been paying for for 17 years. Grossly unfair. We will take part in a class action suit to prevent John Hancock from doing this.
Posted by Vicki Yongelman
on
I too have the same complaint as Kathryn Davis. I have my Long Term Care Policy since 2002.I was 60 years old at the time.I too have had too give up benefits for inflation they claim. I have NEVER made a claim that policy. Now agan another 30 % raisee unless I take another loss of benefits. Soon the poLucy will be worth nothing. If and when I will ever need it it will be a worthless piece of paper. They say they are not discriminatory. That is baloney they kow the age of every policy holder. We need a Law Firm willing to do a Class Action Suit. There is already a Clas Action Suit against John Hancock for not paying after a client is admitted to a Nursing Home. There is no suit yet for raising premiums on older policies. Come on people lets get this rolling.
Vicki Youngelman
Posted 3/ 5 /17
Posted by Kathryn Davis
on
I am very frustrated with John Hancock and the way they are manipulating long term policy holders. After several rate increases, in 2014 they almost doubled my premiums but allowed premiums to be reduced if I would agree to reduce my coverage. My choice was to reduce my coverage or give up policy. I agreed to reduce my number of years of benefits from unlimited to 6 years and my cost of living increase from 5% compound to 3.4% compound to get a premium that was affordable. Just got my bill for 2016 and guess what! They are again increasing my premium $192 or again a choice of reducing my benefits further. Before long I will have no benefits and a premium that is totally unaffordable. Where are our state insurance commissioners? How can this be possible? I can certainly understand raising the cost of long term care insurance to new policy purchases. But for someone that has paid in for 15 years and now being put in a position of losing their coverage due to outrageous premium increases and reductions in coverage should not be allowed! Are there any class action law suits regarding this treatment to policy holders?
Posted by Linda Conley
on
Ambetter marketplace insurance has raised premiums with high deductibles leaving low income families struggling to pay for something that they cannot afford to use. Deductibles of $4,000 to $6800 mean that families are our of pocket for all of their medical expenses and con only use drugs on their list I stead of thuem covering drugs that the primary care doctor prescribe. Some medications causes allergenic reactions. They get to choose your doctor and your treaments. This is not what the Affordable Care Act claimed. We were to keep our doctors and we're to get affordable insuranxe. My guess would be that since insurance is required, families are being taken advantage of and are left with insurance that they cannot be if it from. I know that I have been faced with getting insurance and every year premiums go up along with the deductible or they no longer carry that same insurance and you are trying to find something within your budget. To me this is bait and switch. People are being taken advantage of and low income families are suffering as a result.
Posted by annette williams
on
Hi, didn't John Hancock Merge over to met life? and I was wondering my mom passed away in 2009 and I called about her life insurance to see if they could of send me what she paid in full to them. but it went to Met Life and they said the records of her policy is no long in service do to the fire they had. but I have my mom policy. so what should I do about fighting that, because us kids deserved this money. I was my mom power of Attorney and her reprehensive. payee. I tried fighting this on my own but failed.
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