Insurance Agent Overcomes Wrongful Long-Term Care Policy Denial, Wins $1.95M Settlement

No matter how proactive you might be, facing a massive insurance company on your own is a daunting task, often leading to unfair outcomes. Our recent client, an insurance agent who, thankfully, purchased a long-term care policy when she was young and healthy, learned this when her benefits were abruptly discontinued. This is where Donahue & Horrow LLP stepped into the picture with an arsenal of expertise and dedication to fight for a resolution that allowed this client to focus on her health and wellbeing with a proper award from the insurance company.

Our client was compelled to rely on her long-term care policy when she began to experience a severe cognitive impairment as a consequence of heart surgery complications. Her long-term healthcare policy, a product of her foresight, promised to finance her necessary medical care and the various assistants required to manage her affairs. However, after eleven years of receiving her rightful benefits, the insurance company abruptly reneged on their agreement, not only denying ongoing benefits but also demanding reimbursement for the previously provided assistance. The insurance company sued her for these benefits.  

Daunted with the prospect of fighting the insurance company alone, she sought the expertise of  Michael Horrow and his team at Donahue and Horrow LLP to assist her in the lawsuit. Our firm quickly answered the lawsuit, and filed counterclaims for breach of contract, breach of the covenant of good faith and fair dealing (also known as insurance bad faith), and punitive damages. The litigation was contentious, with numerous discovery disputes and a failed attempt at mediating the case. Throughout the lawsuit, we worked tirelessly with our client to ensure that she continued to receive care and assistance, and submitted the invoices to the insurance company for payment. The insurer maintained its position that it was not obligated to make payments to our client and continued to demand reimbursement of some of the previously paid benefits.

Finally, a judge ordered the insurance company to pay our client all past-due benefits. Following a partial payment by the insurer, our client and the insurance company agreed to a second mediation. This mediation was successful, resulting in a confidential settlement that will allow our client to continue to receive the assistance and care that even the insurance company, at one time, agreed that she needed.  Furthermore, she is liberated from the monthly ordeal of submitting invoices, hoping for timely payment, and the persistent anxiety of being watched and recorded whenever she leaves her house, as had occurred several times before. Now, our client can focus on recovery and her future.

If you or a loved one have a long-term care policy that the insurance company is improperly refusing to honor, call Donahue & Horrow LLP at (877) 664-5407 for a free consultation.