The thing that maybe we haven't really talked about is that I want the children more than the individuals to understand that we are advocates in the strongest sense of the word. That we're not just trying to drill down into some insurance policy and win a case. A lot of the children live out of town and it's very difficult for them to deal with the problems of their parents. Number one would be where to place them, how to place them, what other people work in this industry, such as caseworkers, social workers can direct them in where to … [Read more...]

There is a nurse registry issue that registries might be interested in. I have started a class action case involving registries. The issue is the companies, there's a difference between a nurse registry and a home health agency. They're not exactly the same although they are licensed to do exactly the same thing, which is to provide home care. A lot of the insurance policies refuse to pay for benefits when the services have been provided by a nurse registry. They will only pay for services provided by a home health agency. In 1996 … [Read more...]

I'm going to discuss the concept of assignment of benefit and how important it is in the long-term care world. It's important for a couple of reasons. Number one, when an individual needs care and they have a policy, if the provider, meaning the registry or agency does not take an assignment, that means the individual has to start paying out of pocket until the insurance company begins to reimburse. People can't afford to do that so they'd be stuck having to find money in order to get their care commenced. What the assignment does is it … [Read more...]

The bottom line with the decision to hire a lawyer or any professional is are you hiring somebody who is competent and committed? Competent to handle the matter and committed so seeing it all the way through. These particular policies in this industry requires someone with some degree of specialized knowledge and experience in dealing with the issues. The main thing with hiring somebody who isn't per se experienced in doing this is they may miss issues; they may not understand everything they need to in order to adequately handle the matter. … [Read more...]

I've followed in my father's footsteps as far as the profession and direction of the type of work I would do. You know, my father grew up in a modest, poor environment and he always represented people who were needy, always. Working people and that's what I did. I went in with him and did what he did. We represented working people forever and I evolved into representing people who worked on ships and those people when they get hurt, they're very needy. When they get hurt I got a lot of satisfaction helping those people and I still do. … [Read more...]

If people are in the market to purchase long term care policies, as I would do myself, I would ask the long term care insurance company that I'm considering buying from to give me a prototype of the policy. I'll be happy to read it for people and let them know if it's a good policy or not or if they could possibly have problems down the road with it. I don't really want to promote any particular company because it's not what I do. I promote buying long-term care for sure, I think it's a critical thing to have and I'm just telling people that … [Read more...]

The reason to bring a class action law suit, particularly in the long term care insurance field is because you want to reach as many people as you can in one case. If there are 100 or 400 or 500 or 1000 people being affected by the conduct of the insurance company, the purpose of the class action suit is to reach all of those people and get all of those people relief in one case. Otherwise, you first have to have all the people who are aggrieved know they have a claim, then they have to get a lawyer on their own, bring individual cases for … [Read more...]

I've had that with my registry clients where they're told that policy benefit is maxed out and actually in the very beginning of all this, when the registries or agencies weren't getting paid by the insurers of course they were looking to their clients to pay. When they were told policy benefits had expired they would just stop care and then they'd pretty much lose their client. They would drift away for two reasons. One, if you start to pursue claims against your own client, they're no longer your client. You're now adversaries. Number … [Read more...]

It's really a big problem that when the agencies, registries and insured people are calling the insurers for insurance verification, insurance information, coverage issues, when the insurer says no, they accept it. It's such a huge problem because there's an inherent conflict of interest where the insurer is the entity paying and also being asked advice about whether they should be paying. I like to believe that people always do the right thing for the right reasons but when there's a conflict of interest you have to have a third eye … [Read more...]

What we offer to do is to look at anybody's policy and offer some advice or give insight into what their policy covers and what they may be confronted with if they start making claims. In other words we try to advise them of what the issues are in their policy and we'll do that for anybody. We give people a free look. It's probably better to have somebody look at the policy before you need to claim into it then once you're in it because when you're in it and having difficulties, those difficulties are compounded when benefits aren't getting … [Read more...]

The very first case that I got involved in, like I said earlier was my father's case. He had what was called a home care policy. A home care policy is designed to pay for an aide or attendant to come into the home to provide what is called assistance with the activities of daily living. Those activities include bathing, dressing, feeding, walking, transferring from a sitting to a standing position, and all those types of things that we all take for granted. When my father went into assisted living and the insurance company denied the … [Read more...]

Let me talk a little more about fuzzy language and connect that to what the courts actually are saying about it, what they will do, what they are being directed to do by the appellate courts in our state, which is this fuzzy language concept in these insurance policies. That is to me the most important focus that a lawyer should place on this whole insurance thing. The appellate court in the case that I talked about which I brought, made it clear to all the courts in Florida how the courts are supposed to view these long-term care … [Read more...]

This is what happens; the longer it takes for the insurance companies to pay the more difficult it becomes for the provider the agency or registry and person getting the care. It's just pressure. The agency or registry, they're paying their caregivers for the care and waiting to be paid by the insurance company. They can only do that for so long. So that kind of pressure obviously gets thrown toward the person receiving the care and the family. We're not getting paid, we need a credit card. We need you to pay us. If you don't pay us, … [Read more...]

There is a problem that I see emerging and I don't even know if it's just emerging. It's probably something that's been going on for years before I ever got involved with this. It's where the insurance company will undercut a plan of care that has been laid out for somebody and signed off on by that persons physician. Basically, the way it works is when an individual needs care,  in order to access policy benefits, they have to be assessed by a medical professional. That entails having somebody physically go to the home, take a look at the … [Read more...]

The appellate decision involved a case that I brought on behalf of a nurse registry. They had been providing care to this individual and the insurance company refused to pay certain benefits. It was a policy that was I believe poorly written and basically what the policy required was for an individual to have what is called a skilled visit by a nurse or a therapist at least once a week in order to receive benefits for unskilled care like assistance with bathing and dressing and ambulating or walking, things like that. The individual in that … [Read more...]

Unfortunately my father who I worked with for many years became ill and it turns out that he purchased a long-term care policy. We had to make the difficult decision to place him in an assisted living facility, which is expensive, and we then sought for his long-term care insurance company to pay some of the charges associated with his care there. When they declined to do that, I was forced to file a lawsuit against the company and I did. It was during that process that I realized first of all how neglected the field is. There was no law in … [Read more...]