Lawsuit filed over denial of senior's home care
A lawsuit contends that a health insurer ran a scheme to avoid paying in-home care claims for potentially thousands of California's elderly.
Senior Health Insurance Company of Pennsylvania, or SHIP, had a claims process "designed to frustrate and confuse policyholders with needless demands for irrelevant information" in violation of its own policies and California law, according to the suit filed Tuesday in San Bernardino County Superior Court by the group Consumer Watchdog.
"They're preying on the elderly," group founder Harvey Rosenfield said Wednesday.
A call to the Carmel, Ind.-based company seeking comment was not immediately returned.
The not-for-profit insurer is run by a trust created by the Pennsylvania Insurance Department. It was previously known as Conseco Senior Health Insurance Company and services long-term policies originally sold by Conseco, American Travelers Life, Transport Life, United General Life, and Continental Life.
It has about 10,000 California policyholders, Rosenfield said.
The average age of its policyholders in 2009 was 80, according to the California Department of Insurance. That year, the company agreed to pay $500,000 to settle claims by state regulators that it had improperly denied claims on long-term care policies and that its claims-handling practices were confusing and onerous. The company agreed to repay claims dating back to 2004.
The new lawsuit makes similar allegations. It alleges that SHIP tried to avoid reimbursing policyholders for long-term care by ignoring or taking an unreasonably long time to respond to claims; requiring unnecessary paperwork and medical examinations, and requiring that the caregivers have licenses in violation of company policy and California law.
The suit, which seeks class-action status, was filed on behalf of Dr. William Hall, 78, of Upland. Hall, a retired chief of medicine at a California hospital, bought a long-term care policy in 1994 and submitted claims in 2010. SHIP refused to reimburse all but 20 percent of his expenses.
Co Conseco Health Insurance Senior - News
A call to the Carmel, Ind.-based company seeking comment was not immediately returned. The not-for-profit insurer is run by a trust created by the Pennsylvania Insurance Department. It was previously known as Conseco Senior Health Insurance Company and
4 in San Bernardino County Superior Court by the group Consumer Watchdog. The not-for-profit insurer is run by a trust created by the Pennsylvania Insurance Department. Senior Health Insurance operated as Conseco Senior Health Insurance until late 2008
Fitch Ratings upgraded its ratings on CNO Financial Group Inc. (CNO) and its core insurance subsidiaries, citing the company's improved capital position, earnings profile and financial flexibility. The ratings firm raised its issuer default rating and
CNO Financial Group, Inc., formerly Conseco, Inc., is the holding company for a group of insurance companies operating throughout the United States that develop, market and administer supplemental health insurance, annuity, individual life insurance
Senior Health Insurance Company of Pennsylvania (SHIP) Sued for ...
Consumers Who Bought Long-term Care from SHIP (formerly Conseco) Left To Fend for Themselves
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 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.