Founder Evan Schwartz, Partner Michail Hack, Paralegal Christine Kingsley
A woman purchased a long-term care insurance policy from Prudential in 2003. She and her husband had spent years caring for their young daughter day and night, after a lightning strike had left the child in need of around-the-clock care. Determined not to place the same burden on her family for her own care, she paid the insurance premiums for years, expecting coverage if she eventually needed help with daily activities. At age 78, that day came. The policyholder filed a long-term care claim in 2018, but Prudential said no. When she appealed, with letters from her doctors, she was told to send more records. Then more. Months went by, and her appeal was denied too. That’s when she called us.
The Challenge
The policy promised benefits if the policyholder needed substantial assistance with at least two of the six activities of daily living – bathing, continence, dressing, eating, toileting, and transferring – for at least 90 consecutive days. Despite medical records, physical therapy notes, and statements from the policyholder, her husband, and healthcare providers supporting her claim that her condition met the policy requirements, Prudential denied her initial application and appeal.
She retained Schwartz Conroy & Hack, PC, whose Founder Evan Schwartz and Partner Michail Hack, assisted by Paralegal Christine Kingsley, filed suit against Prudential and its third-party administrators in 2019. The legal team submitted extensive medical documentation and challenged the companies’ handling of the client’s claim. Prudential then approved the claim in 2021 and began paying benefits, but the fight wasn’t over. In 2023, Prudential terminated the benefits. As the Court noted, the insurer relied entirely on a physician’s check-the-box form indicating that the policyholder was independent in all six activities of daily living. The physician had only seen the client once and had not examined her for that purpose.
The policyholder went eleven months without the benefits she had paid for, leaving her uncertain about what lay ahead. Finally, Prudential – realizing how badly it had bungled her claim, again – decided to reinstate her claim and pay her the back benefits for the eleven-month period that it should never have stopped paying.
The amended lawsuit against Prudential and its third-party administrators alleges contract breaches, bad faith, unreasonable business practices, and conspiracy. The client seeks recovery of denied benefits under the insurance contract as well as tort and statutory damages arising from the processing of her claims and appeals.
Among the allegations, the lawsuit claims that, under its contract with Prudential, the third-party administrator handling the policyholder’s claim was paid extra for each month a claim remained under review. Prudential argued it had no reason to pay more for drawn-out reviews. The judge disagreed, writing that paying the administrator more is “certainly less costly to Prudential than paying out a LTC policy.”
Prudential and its claims administrators asked the Court to throw out our client’s claims of bad faith, unreasonable delay, and conspiracy. The insurers also argued that New Hampshire law, which gives policyholders far less protection, should apply to this lawsuit (our client filed the initial claim in that state). We fought for Colorado law, where our client bought the policy and was a long-time resident.
The Result
On September 30, 2026, a judge in the U.S. District Court for New Jersey ruled that our client’s case will go to a jury.
In a 48-page opinion, the Court refused to throw out our client’s claims of bad faith, unreasonable delay, and conspiracy. The Court also agreed with us that Colorado law applies. That means a jury can now consider damages for the stress and anxiety our client suffered, along with attorney’s fees, emotional distress, and additional penalties that Colorado law imposes on insurers that unreasonably delay or deny benefits.
The Court also rejected the insurers’ argument that paying her benefits late wiped the slate clean. Under Colorado law, an insurer that eventually pays can still be held responsible for how it treated its policyholder.
Our client has been fighting since 2018, and we have been beside her since Prudential first denied her claim and her appeals. We are ready to tell her story to a jury.
If your long-term care insurance claim has been denied or is being challenged, contact Schwartz, Conroy & Hack, PC. We have the expertise and tenacity to make insurance companies keep the promises they made to policyholders like you.