Long Term Care Horrible Experience W/Allstate

Discussion in 'Long Term Care Insurance Forum' started by Badandy1, Jun 1, 2017.

  1. Badandy1
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    Badandy1 Member

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    I copied Verbatim.
    No where is skilled nursing stated. His facility meets exact criteria and is licensed as
    RCF. Thanks!!
     
  2. VolAgent
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    VolAgent Well-Known Member

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    Then I guess it depends on how upset you are and how quickly you want to escalate things.

    You can start with Allstate, see if they have a mechanism via which you can dispute their claim determination. Just make sure you do not surrender any rights to later sue if you do so.

    You can also file a complaint with the State Department of Insurance.

    And finally you can contact an attorney about a possible suit for bad faith claims handling.

    Just so you know, only your father or his representative acting on his behalf has any rights under the policy. You have not mentioned why he needs care. If he is unable to handle his own affairs, you need someone to have POA so they can act on his behalf.

    Finally, be aware that Allstate may fight every step of the way, or the may immediately agree to pay for the ALF. If you go down this road, be prepared to see it to the end. You can also simply use a facility they are willing to pay for if you and your family aren't up to fighting it.

    I realize in some ways that is giving up, but there is no point to engaging in a battle you aren't willing to see to the bitter end, no matter how right you are. There is no guarantee you will win. On the face of it, I agree with your position, although I am not an attorney nor a decider of facts (jury or DOI official).

    I will add, there is also media, social and mainstream. You can certainly take this to the court of public opinion.

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    Something I will add as it just occurred to me.

    Legally your father may not have been "harmed" yet. Has he been admitted to the facility of your choice, that you feel meets the definition under the policy? Has Allstate refused to pay benefits?

    This is where an attorney would be helpful. I believe until a claim has been submitted and denied, then there is no bad faith. It is all speculative.

    Again, this is where an attorney would be beneficial as they know the law and what has to happen to have a valid suit.
     
  3. Mr_Ed
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    Mr_Ed Well-Known Member

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    which state does he live in now?
    which state did he live in when he purchased the policy?
    Is it a group policy or an individual policy?
    Does it have any home care benefits?
     
  4. Badandy1
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    Badandy1 Member

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    You are amazing Mr Ed!
    My father moved in March 29,2017. We just now received the denial letter.
    I have filed complaints with
    State of Indiana Department of Insurance
    Attorney General
    State Representative
    GMA Investigates
    Call Six for Help
    My sister is scheduled to speak on TV !
    The policy is a joint policy with his now -deceased wife. Purchased in Indiana , 1991.
    Our loss currently is two months rent as he has met the waiting period thru use of his home health care benefit.
    His policy covers: Nursing Home, Home Care, and Adult Day Care. All explicitly defined in the contract.
    My sister and I are his legal POA.
    We have submitted a facility au
     
  5. Mr_Ed
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    Mr_Ed Well-Known Member

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    Can you scan and image the denial letter?

    fyi... when you go on t.v. tell them that you understand that this is a common problem for policies purchased in the 80's and early 90's. Most policies purchased after 1996 don't have this problem.
     
  6. yankee466
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    yankee466 Well-Known Member

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    I think a lot of people back in the day purchased "nursing home policies"......and that is all they cover. Common complaint when someone winds up in assisted living(ALF)

    I remember when I was young (long ago) that when grandma and grandpa got sick, they went to the "nursing home". I tell my clients today that baby boomers want to stay home as long as possible, then maybe assisted living.......and only if things ever turn dreadful, maybe a nursing home when assisted living won't take you....someplace you hope you never go to.

    Essentially all policies sold today are referred to as comprehensive LTC policies.....as the money they make available can be used for home care, ALF, and NH....not to mention a variety of in between options. Very few carriers offer plans that may limit to only HHC, or only facility care.

    If the policy does not specifically define an assisted living community definition...which does NOT have 24 hour on site skilled care....then it creates the issue. Assisted living typically has a RN on site for 8-10 hours a day, then the rest of the time is no more than Med Cart, and babysitters, aka people whose instructions are to call 911 at the drop of a hat....aka, not a nursing home.
     
    Last edited: Jun 7, 2017
  7. Badandy1
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    Badandy1 Member

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    This ALF has 24/7 RN at each station . The care is excellent.

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    This ALF has 24/7 RN at each station . The care is excellent.

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    If I can figure out to attach a picture, I will be able to show you the Denial Letter
     
  8. yankee466
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    yankee466 Well-Known Member

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    well.....I guess it adds credence to the statement I will often make to my clients...which is that I do not recommend they buy a life/health product from a home/auto shop. :biggrin:

    Sounds like you have a valid debate topic.
     
  9. walthamny
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    walthamny Well-Known Member

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    Good luck with your PR campaign.
     
  10. VolAgent
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    VolAgent Well-Known Member

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    Badandy, it sounds like you have done all you can do. Not sure there is anyone else to complain to who would care.

    At this, I would say you are at the point I mentioned earlier, you are going to have to fight this to the bitter end. You may wish to retain an attorney at this point.

    Your complaints, particularly to Allstate, the DOI, and the Attorney General may not have been written in the manner that will best produce results. That isn't your fault, most of us are not professional complainers who know how to get results. Fortunately, a good attorney knows how to properly write a letter to typically get results.

    I wish you well with the fight. To me it seems you have a valid complaint, of course I am not privy to all information so my opinion is worth exactly what you paid for it.
     

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