Thursday, January 29, 2015
FAIRFIELD-SUISUN, CALIFORNIA
99 CENTS

Lawsuit an indictment on long-term care insurance

elias column sig

By
From page A11 | July 24, 2013 |

Back in 1996, Monterey resident Janice O’Brien, then 75, began paying almost $5,000 per year for long-term care insurance. Her idea was that should she ever need them, per-diem payments from the Continental Casualty Co. policy would prevent her ever becoming a burden to her seven children.

It hasn’t exactly worked out that way for Mrs. O’Brien, a past president of the League of Women Voters of the Monterey Peninsula, one of whose sons, Pete O’Brien, played first base for the Texas Rangers, Seattle Mariners and Cleveland Indians for 11 seasons.

Her case and the lawsuit her family filed over it serve as a cautionary tale for policy buyers, but a large judgment or settlement might also be a warning to recalcitrant insurance companies.

Now almost 92, Mrs. O’Brien began sensing signs of dementia in 2011 and she, her children and doctors determined she should no longer live alone. She also had frequent dizziness, interfering with her mobility, and needed help doling out her medications, getting to the toilet and bathing. All of those are among the criteria for payouts from long-term care insurance policies.

So she and her family brought in home care providers, expecting Continental Casualty, usually called CNA, to pay the daily rate called for in her policy. The family made sure her premium payments were always up to date.

The lawsuit says CNA refused to cover more than 49 hours per week, saying the round-the-clock care Mrs. O’Brien got was not medically necessary, even though every doctor consulted said it was. No one in the family was wealthy enough to keep paying caregivers $20 to $24 per hour for all but 49 hours per week.

Eventually, the family gave up on CNA paying much and a daughter, in her 60s, sold her travel agency in Washington state to move in with her mom as a full-time caregiver. Still, CNA refused to pay up.

Nationally, state insurance commissioners receive more than 5,000 complaints yearly of payment refusals by long-term care insurance companies. Most don’t become high-profile lawsuits, but the O’Briens found their way to a Claremont-based law firm headed by William Shernoff, who has won hundreds of millions of dollars from insurance companies that refuse to pay on policies.

Their suit, filed by Shernoff partner Samuel Bruchey, calls CNA’s claims process “abusive” and says it victimizes “society’s most vulnerable . . . CNA deliberately places demands on policyholders that . . . could only be (intended) to cook up grounds to deny claims.”

A CNA spokeswoman said the company won’t discuss pending litigation, but Bruchey said after the suit was filed, the company offered to compensate the O’Briens for everything they have spent on home care this year. Bruchey says his clients won’t be satisfied with mere compensation for what they’ve spent this year.

Even before she gave up her business, the daughter said, she and her siblings were taking care of their mom in relays, each staying with her 30 days at a time. The family wants compensation for what it’s gone through along with punitive damages to deter similar practices.

California law requires that long-term care policies list seven conditions, any two of which can trigger payouts. But the lawsuit charges Mrs. O’Brien’s policy, sold after that law took effect, only included five, making it tougher to qualify for payouts.

“It was never the intent of the drafters of the law to demand impairment so great that people would be forced into nursing homes before they could get payment,” said Bonnie Burns, a Scotts Valley-based insurance consultant who helped write the law. “Long-term care benefits are not intended just for people with impairment so great they need 24-hour care.”

One 2008 report indicated that about 25 percent of all long-term care claims go unpaid because insurance companies insist policy holders be so impaired that almost no one can qualify. The O’Briens want their lawsuit to at least limit that alleged practice.

The bottom line for insurance buyers barraged by television commercials and direct mail ads pushing long-term care insurance: Make sure any policy you buy contains all seven conditions California requires and says only two must be met in order to trigger payouts.

It’s a classic “caveat emptor” – buyer beware situation that has already left many thousands of policy holders frustrated and living less well than they expected in their later years.

Thomas Elias is a California author. Reach him at [email protected]

LEAVE A COMMENT

Discussion | No comments

The Daily Republic does not necessarily condone the comments here, nor does it review every post. Read our full policy

.

Solano News

 
1st release for birds with mysterious goo a success

By Amy Maginnis-Honey | From Page: A1 | Gallery

Vacaville police seek help to find sex offender

By Kevin W. Green | From Page: A3, 2 Comments | Gallery

 
Sweep by sheriff’s team nets 4 arrests

By Kevin W. Green | From Page: A3, 3 Comments

 
 
Travis starts work on Functional Fitness Center

By Ian Thompson | From Page: A3

 
Boy Scouts to screen award-winning film

By Ian Thompson | From Page: A3

 
Church makes ready for health, wellness fair

By Susan Hiland | From Page: A3

4-H Annual Presentation Day returns in February

By Susan Hiland | From Page: A3

 
Vacaville SWAT team serves search warrant

By Kevin W. Green | From Page: A3

Real estate occupancy continues to climb

By Kevin W. Green | From Page: A3, 1 Comment

 
Lights out for proposed electronic sign in Vacaville

By Ryan McCarthy | From Page: A3

 
Council backs beer, wine sales for Vacaville store

By Ryan McCarthy | From Page: A3

Suisun City police log: Jan. 27, 2015

By Susan Hiland | From Page: A10, 1 Comment

 
Fairfield police log: Jan. 27, 2015

By Susan Hiland | From Page: A10

.

US / World

Poll: High approval for Gov. Jerry Brown, support for budget

By The Associated Press | From Page: A1

 
Air Force probing alleged ‘treason’ remark by general

By The Associated Press | From Page: A1, 1 Comment | Gallery

Expect tiny tuxes but no real puppy love at doggy weddings

By The Associated Press | From Page: A2 | Gallery

 
Violations mount for toxic recycler

By The Associated Press | From Page: A4

Quake rattles N. California coast

By The Associated Press | From Page: A4

 
Second arrest in student stabbing

By The Associated Press | From Page: A4

Large salmon release planned

By The Associated Press | From Page: A4

 
Marshals track down missing treasure hunter

By The Associated Press | From Page: A5

‘Drunk’ excuse falls flat in Vandy rape trial

By The Associated Press | From Page: A5

 
Attorney General nominee defends Obama immigration changes

By The Associated Press | From Page: A5, 1 Comment | Gallery

Police seek law to alter Google app

By The Associated Press | From Page: A5, 1 Comment

 
Euro coast guards scramble to locate Syrian ghost ship

By The Associated Press | From Page: A6

Chinese regulators go after online sale of fake goods

By The Associated Press | From Page: A6

 
Investigation stems from police-involved shooting outbreak

By The Associated Press | From Page: A6

Hezbollah missiles kill soldiers

By New York Times | From Page: A6

 
ISIS extends hostage deadline

By The Associated Press | From Page: A6

Tape: Scientist offers to build nuke bomb targeting New York

By The Associated Press | From Page: A10 | Gallery

 
.

Opinion

A truly misinformed writer

By Letter to the Editor | From Page: A7, 5 Comments

 
India now has 322 billion reasons to fix economy

By William Pesek | From Page: A7

Don’t brush off bullying

By Kelvin Wade | From Page: A7, 1 Comment

 
Editorial Cartoon: Jan. 29, 2015

By Daily Republic Syndicated Content | From Page: A7

 
Just be honest and come forward

By Letter to the Editor | From Page: A7, 1 Comment

.

Living

Today in History: Jan. 29, 2015

By The Associated Press | From Page: A2

 
Community Calendar: Jan. 29, 2015

By Susan Hiland | From Page: A2

Deadbeat boyfriend ruined my relationship with my granddaughter

By Kathy Mitchell and Marcy Sugar | From Page: A9

 
Horoscope Jan. 29, 2015

By Holiday Mathis | From Page: A9

.

Entertainment

Theater legend Joel Grey reveals that he is gay

By The Associated Press | From Page: B5, 1 Comment

 
Super Bowl advertisers aim not to offend

By The Associated Press | From Page: B5

 
TVGrid

By Daily Republic Syndicated Content | From Page: B5

.

Sports

Kings center DeMarcus Cousins hoping to make All-Star team

By The Associated Press | From Page: B1

 
Rodriguez wrestlers pull out 34-24 win over Wood

By Brian Arnold | From Page: B1 | Gallery

 
Solano men cruise past LMC for biggest win of season

By Daily Republic staff | From Page: B2

NFL players who started young show more thinking problems

By The Associated Press | From Page: B2

 
GM John Schneider has been architect of Seahawks’ success

By The Associated Press | From Page: B2

Patriots not dwelling on last Super Bowl loss in Arizona

By The Associated Press | From Page: B2

 
Woods returns to Phoenix with plenty of memories

By The Associated Press | From Page: B2

Tony Stewart acquires national sprint car series tour

By The Associated Press | From Page: B2

 
Korda, Lewis, Munoz tied for lead at LPGA season opener

By The Associated Press | From Page: B3

Head of NCAA enforcement: Academic misconduct on rise

By The Associated Press | From Page: B3

 
Chicago Cubs’ Ernie Banks statue moved downtown for tribute

By The Associated Press | From Page: B3

Kobe Bryant has surgery, expected to be out for 9 months

By The Associated Press | From Page: B3

 
This date in sports history for Jan. 29, 2015

By The Associated Press | From Page: B4

 
.

Business

.

Obituaries

Joseph Phillip Raiff

By Nancy Green | From Page: A4

 
Dzhon Athanc

By Nancy Green | From Page: A4

.

Comics

Get Fuzzy

By Daily Republic Syndicated Content | From Page: A8

 
Sally Forth

By Daily Republic Syndicated Content | From Page: A8

B.C.

By Daily Republic Syndicated Content | From Page: A8

 
Beetle Bailey

By Daily Republic Syndicated Content | From Page: A8

Frank and Ernest

By Daily Republic Syndicated Content | From Page: A8

 
Garfield

By Daily Republic Syndicated Content | From Page: A8

Dilbert

By Daily Republic Syndicated Content | From Page: A8

 
Pickles

By Daily Republic Syndicated Content | From Page: A8

Wizard of Id

By Daily Republic Syndicated Content | From Page: A8

 
Peanuts

By Daily Republic Syndicated Content | From Page: A8

For Better or Worse

By Daily Republic Syndicated Content | From Page: A8

 
Blondie

By Daily Republic Syndicated Content | From Page: A8

Zits

By Daily Republic Syndicated Content | From Page: A8

 
Rose is Rose

By Daily Republic Syndicated Content | From Page: A8

Baby Blues

By Daily Republic Syndicated Content | From Page: A8

 
Baldo

By Daily Republic Syndicated Content | From Page: A8

Crossword

By Daily Republic Syndicated Content | From Page: A9

 
Bridge

By Daily Republic Syndicated Content | From Page: A9

Word Sleuth

By Daily Republic Syndicated Content | From Page: A9

 
Cryptoquote

By Daily Republic Syndicated Content | From Page: A9

Sudoku

By Daily Republic Syndicated Content | From Page: A9

 

Parse error: syntax error, unexpected '<<' (T_SL) in /www/newspaperfoundation.org/html/wp-content/themes/broadsheet/footer.php on line 101