Michail Hack, Partner
A widowed, retired school teacher was receiving long-term care benefits, which she relied on to cover the hefty cost of living in an assisted living facility. Despite previously approving benefits, her insurance company suddenly challenged her need for long-term care and threatened to terminate her benefits. This would have created an extreme hardship for the policyholder, whose limited fixed income would not allow her to remain in the assisted living facility and receive the care she needed.
The Challenge
Late on a Monday afternoon, Schwartz, Conroy & Hack’s intake coordinator received a call from the policyholder, stating that her insurance company was threatening her valuable benefits and had scheduled a critical in-home assessment the following day at 11 a.m. – 300 miles from our offices.
The Solution
Recognizing the imminent threat to the policyholder’s benefits, our intake coordinator promptly contacted attorney Michail Hack and told him to call the policyholder immediately.
Michail spoke to the client that evening for about two hours and discovered that she did not understand the criteria in her policy that triggered benefits. As air transport was not an option, he drove to prepare her for her in-home assessment before sun-up the following morning. He reviewed her medical history and discussed her restrictions and ability with regard to performing the activities of daily living, including bathing, transferring, toileting and dressing herself. While preparing the client for her in-home assessment, Michail discovered that, in addition to her inability to perform several daily activities independently, she was an extreme fall risk. Indeed, he learned that the client had fallen in her front yard one evening before moving into the assisted living facility. Being unable to get up, she spent the night lying on the lawn until a neighbor discovered her the following morning.
Through careful preparation, Michail ensured this nervous client would not be too abashed to answer some very embarrassing questions during the in-home assessment. These answers were critical to the client’s continued benefits.
Michail sat by the client’s side during the long-term care assessment and ensured that the in-home assessor asked the right questions and saw the adaptive devices in the client’s room. Subsequent to the in-home assessment, Michail met with the facility’s nursing director and made sure that the client’s written “plan of care” (which is reviewed by the insurance company) correctly reflected all of the activities of daily living for which the client required assistance.
The Result
Presented with substantial evidence during the in-home assessment, the long-term care insurance company came to its senses and continued to provide our client with the benefits she was entitled to under the terms of her policy. Because of our diligence and expertise in long-term care insurance, our client was able to dodge the dangerous threat of living alone.
If you or someone you know is facing similar uncertainty with a long-term care claim, contact Schwartz, Conroy and Hack, PC to evaluate your case. We have the expertise and tenacity to make insurance companies keep the promises they make to policyholders like you.
