Long-Term Care Insurer Cannot Be Sued for Elder Financial Abuse

Long-term care insurance policyholders suing Bankers Life and Casualty Company were dealt a blow by the Oregon Supreme Court when it ruled that the state's elder financial abuse statute does not apply to their case.

Residents of Oregon who bought long-term care insurance policies from Bankers Life and Casualty Company sued the insurer five years ago in federal court. The policyholders claimed that the company violated Oregon's elder financial abuse law by purposely delaying and denying insurance claims. The policyholders alleged that, among other things, the company didn't answer phone calls, lost documents, wrongly denied claims, and paid less than policyholders were entitled to.

The lead plaintiff, 87-year-old Lorraine Bates, moved into an adult foster home in 2009 but Bankers refused to pay her claim, saying the facility didn't meet its policy requirements. Another plaintiff, Eileen Burk, purchased a long-term health-care policy from Bankers.  After she moved into an assisted living facility, her son had trouble filing a claim with the insurance company because the company refused to assist him.

After the federal district court dismissed the lawsuit, the policyholders appealed to the U.S. Court of Appeals for the Ninth Circuit.  Because the legal question centered on the state’s elder financial abuse law, the appeals court asked the Oregon Supreme Court to determine whether the policyholders could sue the insurer under state law for wrongful withholding of money. The financial abuse law prohibits an entity or person that is holding or controlling an elderly person's money from withholding that money if the money was acquired from the elderly person. The policyholders argued that the insurance company acquired money in the form of premiums from the insurance company and then refused to return it in the form of benefits.

The Oregon Supreme Court determined that the elder financial abuse statute does not apply to an insurance company that delayed the processing of claims and refused to pay benefits. The court rules that the law applies only when one person or entity holds the money that still “belongs to” the elderly person. According to the court, the money the policyholders paid to Bankers became Bankers' money and no longer belonged to the policyholders.

To read the Oregon court’s decision, go here: http://www.publications.ojd.state.or.us/docs/S064742.pdf

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