Long Term Care Horrible Experience W/Allstate

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

  1. walthamny
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    walthamny Well-Known Member

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    Some tips for hiring an attorney in this case.

    It helps if the attorney has experience with insurance contract law. Most civil attorneys law about their state contract law but most of the time insurance company will fight these because they will claim there is a different statue for insurance contracts law and they will bring up obscure insurance contract case law decisions from over 100 years ago.

    You also need to hire an attorney who is mean, someone you really dislike, (&^%$# personality. You can hire a nice, gentle attorney and make your father happy but cases like this really shine for the type I mentioned.
     
  2. Badandy1
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    Badandy1 Member

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    Thanks for all the great advice! Our attorney feels this may have Class Action potential !!
     
  3. LGilmore
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    LGilmore Well-Known Member

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    "Allstate tells me that they "used " to pay Assisted Living, but have now changed their minds. Coincidentally, they changed their minds when they recieved my Fathers claim. "

    This is what I meant by make sure you're working off the same policy language. Insurers change policy offerings every so often and in those changes, new definitions or features come on or drop off. The thing is these changes should only apply to new business.

    They will have to go by the contract language in your dad's plan. They don't get to change it to something else. This can be a good or bad thing depending on the option we're talking about.

    I would go through your dad's policy and call them and make absolutely sure you are both working from the same policy plan.

    As I said before I had a similar problem over wavier of premium on my life policy taken out about 30 years ago. The definition of disability and how the waiver applies had changed two times since I purchased. First two customer service reps kept telling me something that wasn't in my policy. I had to point out the series I was working from, not what is currently for sale. Asked for a third customer service rep who knew the old policies.

    Then it was a snap to take care of. Remember customer service reps are not versed in policy language, they read back what the screen says to you. They may have only been working there 6 months.

    Make sure everything is on the same page. If they still disagree, ask for them to put it in writing and then submit to your OIC for them to work on.

    make triple sure. But also understand they may have given you the wrong information because of what I just wrote as well. The big thing is make sure everybody matches.
    "
     
  4. Mr_Ed
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    Mr_Ed Well-Known Member

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    if this was a group policy, then his father would only have a certificate and the benefits could have been changed without his father's knowledge or consent.

    That's why I asked if it was a group policy or if it was purchased as an individual.

    I think the OP used the phrase "certificate" to describe his father's policy which leads me to believe it is a group policy.
     
  5. LGilmore
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    LGilmore Well-Known Member

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    Could be, then it would be year to year. Same point applies, they need to make sure everything matches on both ends, so they can move forward. The first information the OP got could have been what was incorrect to. It will depend on the policy language inforce at the time.
     
  6. Badandy1
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    Badandy1 Member

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    I wanted to let everyone know how this ended up. I submitted a complaint to Indiana Department of Insurance , called and spoke to my "complaint consultant" . She became very intrigued when I explained the denial reason was , "We Changed our Minds" !
    When I then told her I had documented all the phone calls ( Stating that Assisted Living was covered) and Allstate told me they would not release the phone calls with out a subpeona, she was really intrigued.
    My "Problem Counselor" Called Allstate that day and requested the phone call transcripts.
    Interestingly enough, The Vice President of Claims phoned me that afternoon to say " They would pay the benefits as an Accommodation only, ( meaning this is a negotiated deal) and she reminded me that our policy is "a nursing home policy only. (It is not!)
    We have several Attorneys interested in a Class Action Lawsuit. If you know of consumers with policies such as this, please let me know!
     
  7. NeedHelpForGrandpa
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    NeedHelpForGrandpa New Member

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    Badandy1, so glad to hear that this ended well for you. We are going through the EXACT same thing with Allstate now. Grateful for your posts and follow-up. Crossing our fingers for a similar outcome!
     
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