Case Result

The number of older Americans is growing at a rapid pace. In 2022, 17.3% of the population was 65 or older. The number is projected to increase to 22% by 2040. One of the unfortunate realities of aging is that medical problems can rob a person of their independence. When that happens, an individual must rely on the assistance of others to perform daily tasks that the able-bodied take for granted, such as bathing, dressing, eating, transferring and even toileting. Often, a person must rely on a family member or hired help to assist in the performance of these basic tasks. The cost for such assistance can escalate quickly, but thankfully, long-term care benefits are offered through insurance companies, for this exact situation. 

Donahue & Horrow LLP was contacted by an individual who was having problems with his long-term care insurance carrier. He purchased a long-term care policy in 2008, and dutifully paid annual premiums.  After years of struggling with pain, he was no longer able to bathe and dress himself without assistance from his family. Accordingly, he filed a claim for the long-term care benefits he was entitled to based on the policy he purchased in 2008.. 

Initially, the insurance company agreed that he needed assistance with his Activities of Daily Living (“ADL”) and approved his claim for benefits. After approving the claim, the insurer periodically sent a Nurse Assessor to his home to interview and observe him. Without fail, the Nurse Assessor reported that he needed hands-on assistance with at least two ADLs, usually dressing, transferring and bathing. This went on for about seven years. However, despite a complete lack of evidence showing that our client’s health improved, the insurance company abruptly and wrongfully denied his long-term care claim, robbing him of the continued benefits to which he was rightfully entitled.

After his claim for long-term care benefits was denied, our client contacted Donahue & Horrow LLP. Michael Horrow and his team have years of experience helping insureds fight insurance companies following a wrongful denial of a long-term care claim. Donahue & Horrow LLP quickly filed a lawsuit in Los Angeles County Superior Court, asserting causes of action for breach of contract and breach of the duty of good faith and fair dealing. 

Following extensive written and deposition discovery, the parties agreed to engage a mediator in an attempt to resolve the denied long-term care benefits dispute. The parties agreed to a settlement that resulted in a payment to our client that will allow him to receive the hands-on care he requires and a large settlement based on the wrongful denial of his benefits by the insurance company.  

If you have a long-term care policy and your insurance company is refusing to honor the terms of the policy, call Donahue & Horrow LLP at (877) 664-5407 for a free consultation. Our dedicated team is ready to fight for the long-term care benefits you deserve.