Long Term Care Insurance Fraud in Illinois
Many seniors and older adults consider getting long-term care (LTC) insurance to help cover the costs of care that may be needed in their later years. The purpose of long-term care insurance is to cover medical care for those who live at home, in a nursing home, or assisted living facility who need assistance with two or more Activities of Daily Living (ADLs). The insured individual must prove their inability to handle at least two ADLs for the benefits to become payable.
If older adults and seniors end up needing long-term skilled medical care, or even non-medical home care, the cost for these services could reach as high as $10,000 per month. This means that it can be devastating for seniors to be denied the benefits of long-term care insurance that can cover these costs. It is common for insurance companies to deny claims and raise premiums because these policies are expensive for insurance companies and cause them to lose money. In many of these instances, the insurance provider is acting in bad faith.
If you are being denied the benefits of your long-term care insurance policy or are being overcharged, you may be able to file a claim to lower your rates or get compensation. At Anderson + Wanca, we provide representation for class action lawsuits against long-term care insurance fraud in Illinois. Our attorneys will review your policy terms and determine the best course of action.
What is Long-Term Care Insurance?
Long-term care insurance is insurance that covers the cost of medical and non-medical care for seniors and older adults who cannot perform 2 or more ADLs, such as personal hygiene, dressing, eating, transferring or ambulation, and toileting, and require at least 90 days of care. Those suffering from severe cognitive impairment such as Alzheimer’s disease and other forms of dementia are also eligible for LTC insurance. These insurance policies should cover the cost of required care for the insured at home, in a nursing home, or at a rehabilitation facility.
How Have Long-Term Care Insurance Policies Caused Losses for Insurers?
From the 1990s through the 2000s, insurance companies marketed and sold many LTC insurance policies to those in the baby boomer generation and around seven million of those policies are still in effect. Over the years, these policies have cost insurers billions as those insured have maintained their policies without renewal and on average, they live longer and make claims earlier after getting their policies than anticipated by insurance companies. The fast-rising costs of medical care and related expenses has also contributed to losses for insurers.
Long-Term Care Insurance Fraud
The loss that insurers have taken on LTC insurance policies over the years have led to bad faith actions by insurers to help prevent future losses by raising premiums and denying benefits. The following are some of the ways in which insurers may engage in long-term care insurance fraud:
- Overstated benefits: An insurer may sell an LTC policy by overstating what it covers. They may claim it will cover certain costs while the fine print in the policy says that it will not. This leads the insured to believe that certain costs will be covered by the policy only to later be denied coverage for these costs.
- Application misstatements: An insurer can lower the premium of an LTC insurance policy and entice a person to purchase such a policy by misstating personal information such as the person’s age or medical history. It is illegal to misstate information for an insurance policy and even when it is the insurer who misstates the information, it is possible for the insured to face criminal fraud charges.
- Raising premiums: A common way insurers will try to avoid losses on LTC insurance policies is by raising premiums. This not only puts the insured in a position where they can no longer afford insurance needed to offset the high costs of medical care, but it may also be illegal if the premium is raised beyond the limit set by the state of Illinois or if a policy includes a clause to not raise the premiums after the insured reaches a certain age.
Long-Term Care Insurance Class Action
If you have received a long-term care policy and are now experiencing unexpected rate increases year over year, call our professionals at Anderson + Wanca to review your policy terms. Insurance companies are capable of increasing rates provided they obtain permission from the appropriate agencies and act within the scope of the policy parameters.
If you believe you might have been overcharged, you may be eligible to get your rates reduced and get compensation. You may also be able to bring a long-term care class action suit if an insurer acted in bad faith by enticing you to purchase a policy with low insurance premiums only to raise the premiums after purchase.
Anderson + Wanca is a class action firm that handles cases on a contingency fee basis. We would like to represent all persons in similar situations to help rectify the situation with a long-term care class action settlement. We will need a copy of your insurance policy and most recent premium increase notification letter.
If you are interested in a free consultation to explore whether you have a claim for long-term care insurance fraud in Illinois and may be entitled to compensation, please call us at (888) 505-0953 or email us at LTCinsurance@andersonwanca.com.
We work with attorneys licensed throughout the United States, so you do not have to reside in Illinois to be eligible.