Saturday, April 19, 2014
FAIRFIELD-SUISUN, CALIFORNIA
99 CENTS

Lawsuit an indictment on long-term care insurance

elias column sig

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 tdelias@aol.com.

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

Solano unemployment inches downward

By Barry Eberling | From Page: A1, 2 Comments

 
Transplant recipients talk about their best gifts

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

 
 
Fairfield council candidates weigh in on crime

By Ryan McCarthy | From Page: A3, 3 Comments | Gallery

Police release name of woman found dead in Fairfield canal

By Ryan McCarthy | From Page: A3 | Gallery

 
Spering, Bertani spar over fighting crime

By Ryan McCarthy | From Page: A3, 41 Comments | Gallery

 
Five homes featured on Symphony Home Tour

By Amy Maginnis-Honey | From Page: A4

 
Congregation invites public to Easter music, message

By Amy Maginnis-Honey | From Page: A4

 
Local woman helps spread Easter joy

By Amy Maginnis-Honey | From Page: B12 | Gallery

 
Weather for April 19, 2014

By Daily Republic | From Page: B13

 
.

US / World

California farmers to get more water

By The Associated Press | From Page: A1

 
Teen sentenced in Oakland toddler’s killing

By The Associated Press | From Page: A4

More Latino than white students admitted to UC

By The Associated Press | From Page: A4, 3 Comments

 
Health care site flagged in Heartbleed review

By The Associated Press | From Page: A5

From Clinton to Obama, many parallels

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

 
Study: Half of jailed NYC youths have brain injury

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

PG&E to be arraigned in fatal pipeline blast

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

 
Mom and son who died in San Francisco fire ID’d

By The Associated Press | From Page: A5

3 alleged gang members convicted of murder

By The Associated Press | From Page: A5

 
Colorado deaths stoke worries about pot edibles

By The Associated Press | From Page: A8, 1 Comment

NASA’s moon-orbiting robot crashes down as planned

By The Associated Press | From Page: A8

 
Atheist national conference aims at Mormon church

By The Associated Press | From Page: A8, 5 Comments

Easter on 4/20, pot holy day; pastors reach out

By The Associated Press | From Page: A8, 2 Comments

 
Some countries get Obama, but want his wife, too

By The Associated Press | From Page: A9, 1 Comment

Man who avoided prison is overwhelmed by support

By The Associated Press | From Page: A9

 
Teen suspended for asking Miss America to prom

By The Associated Press | From Page: A9, 1 Comment

White House updating online privacy policy

By The Associated Press | From Page: A9

 
SpaceX making Easter delivery of station supplies

By The Associated Press | From Page: A9

Sudden movement raises alarm in Wyoming slide area

By The Associated Press | From Page: A9

 
In Egypt, a corruption watchdog hit by backlash

By The Associated Press | From Page: A12

Military scales down, modifies Guam buildup plan

By The Associated Press | From Page: A13

 
Captain of sunken SKorean ferry arrested

By The Associated Press | From Page: A13

Avalanche sweeps down Everest, killing at least 12

By The Associated Press | From Page: A13

 
Diplomacy doesn’t move insurgents in Ukraine

By The Associated Press | From Page: A14

Magnitude-7.2 earthquake shakes Mexican capital

By The Associated Press | From Page: A14

 
57-nation OSCE plays key Ukraine monitoring role

By The Associated Press | From Page: A14

Ukraine crisis: The turning points

By The Associated Press | From Page: A14

 
.

Opinion

Here we go again in Sacramento

By Letter to the Editor | From Page: A11, 9 Comments

 
Cheers, jeers for the week of April 13-19, 2014

By Daily Republic | From Page: A11

 
Editorial Cartoons for April 19, 2014

By Daily Republic Syndicated Content | From Page: A11

 
.

Living

Today in History for April 19, 2014

By The Associated Press | From Page: A2

 
Community Calendar: April 19, 2014

By Susan Hiland | From Page: A2

Seniors, it’s never too late to do something about your health

By Kathy Mitchell and Marcy Sugar | From Page: B7

 
Horoscopes for April 19, 2014

By Holiday Mathis | From Page: B7

.

Entertainment

TVGrid

By Daily Republic Syndicated Content | From Page: B10

 
Prince reaches agreement with music label

By The Associated Press | From Page: B14

‘The Boondocks’ back for final ‘offensive’ season

By The Associated Press | From Page: B14

 
A nutty finale for ‘Scandal,’ TV’s craziest show

By The Associated Press | From Page: B14

Stratocaster still a favorite at 60

By The Associated Press | From Page: B14

 
.

Sports

Ross, Padres beat Cain and Giants 2-1

By The Associated Press | From Page: B1 | Gallery

 
A’s come out swinging to beat Astros 11-3

By The Associated Press | From Page: B1

Warriors to start O’Neal for Bogut vs. Clippers

By The Associated Press | From Page: B1

 
Hertl has impressive playoff debut for Sharks

By The Associated Press | From Page: B1

Warriors and Clippers take dislike to playoffs

By The Associated Press | From Page: B1

 
Big innings lift Mustangs over Indians

By Paul Farmer | From Page: B1 | Gallery

’40-and-up club’: Ageless Hopkins after more belts

By The Associated Press | From Page: B2

 
Jimenez shoots 65 to lead Greater Gwinnett field

By The Associated Press | From Page: B2

Solano scores in ninth for 2-1 BVC baseball win over Yuba

By Daily Republic staff | From Page: B2

 
Choi leads rain-delayed RBC Heritage

By The Associated Press | From Page: B2 | Gallery

NBA’s Silver wants age limit change, no rush on others

By The Associated Press | From Page: B2

 
NBA playoffs looking more wide-open than expected

By The Associated Press | From Page: B2

Source: Grizzlies’ G Calathes suspended for 20 games

By The Associated Press | From Page: B2

 
Avalanche sweeps down Everest, killing at least 12

By The Associated Press | From Page: B2

Mets trade 1B Ike Davis to Pirates

By The Associated Press | From Page: B2

 
TNT’s Sager to miss NBA playoffs due to leukemia

By The Associated Press | From Page: B2

Nadal ousted by Ferrer in Monte Carlo quarters

By The Associated Press | From Page: B2 | Gallery

 
A’s lefty reliever Doolittle gets 5-year deal

By The Associated Press | From Page: B2, 1 Comment | Gallery

.

Business

Judge says American can’t end retiree benefits yet

By The Associated Press | From Page: B10

 
Mazda recalls 109,000 older SUVs for rust problem

By The Associated Press | From Page: B10

5 features an Amazon phone might offer

By The Associated Press | From Page: B10

 
.

Obituaries

.

Comics

Rose is Rose

By Daily Republic Syndicated Content | From Page: B6

 
B.C.

By Daily Republic Syndicated Content | From Page: B6

Baby Blues

By Daily Republic Syndicated Content | From Page: B6

 
Pickles

By Daily Republic Syndicated Content | From Page: B6

Baldo

By Daily Republic Syndicated Content | From Page: B6

 
Blondie

By Daily Republic Syndicated Content | From Page: B6

Dilbert

By Daily Republic Syndicated Content | From Page: B6

 
Wizard of Id

By Daily Republic Syndicated Content | From Page: B6

Zits

By Daily Republic Syndicated Content | From Page: B6

 
Garfield

By Daily Republic Syndicated Content | From Page: B6

Frank and Ernest

By Daily Republic Syndicated Content | From Page: B6

 
Get Fuzzy

By Daily Republic Syndicated Content | From Page: B6

Peanuts

By Daily Republic Syndicated Content | From Page: B6

 
Sally Forth

By Daily Republic Syndicated Content | From Page: B6

For Better or Worse

By Daily Republic Syndicated Content | From Page: B6

 
Beetle Bailey

By Daily Republic Syndicated Content | From Page: B6

Cryptoquote

By Daily Republic Syndicated Content | From Page: B7

 
Crossword

By Daily Republic Syndicated Content | From Page: B7

Word Sleuth

By Daily Republic Syndicated Content | From Page: B7

 
Sudoku

By Daily Republic Syndicated Content | From Page: B7

Bridge

By Daily Republic Syndicated Content | From Page: B7

 
.

Home Seller 04/19/14

Summerwood features 8 new homes in Suisun

By Daily Republic | From Page: HSR2

Real estate transactions for April 19, 2014

By Daily Republic | From Page: HSR3

Average US 30-year mortgage rate falls to 4.27 percent

By The Associated Press | From Page: HSR3