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California Long Term Care Insurance

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Millions of people in California have bought long-term care policies believing that when they needed their long-term care insurance benefits, those benefits would be there for them. Unfortunately, many are finding that their long-term care insurance claims are being denied for questionable reasons, leaving the policyholders to pay for their own care, even after they faithfully paid into their policy.

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California Long-Term Care Benefits Denied

Long-term care insurance is designed to cover a policyholder in the event of incapacitation or inability to take care of him or herself. Although individual policies vary, they tend to cover nursing home care, managed care, in-home health care or care at institutional settings, not counting hospitals.

California long-term care insurance companies are accused of unreasonably denying policyholders' claims, even after the policyholders have paid their premiums for years. This has reportedly led to an increase in lawsuits filed against long term insurance companies. Among the reasons California long term care insurers may try to deny claims are:


  • California policyholders failed to submit unimportant paperwork;
  • Daily nursing notes did not detail minute procedures;
  • Policyholders filled out the wrong forms after receiving them from the insurance companies;
  • Companies claiming medical care is not necessary, even if a doctor has deemed the care vital;
  • Facilities were deemed inappropriate even though they were licensed by California state regulators; and
  • Policyholders failed to provide paperwork, but were not informed by the insurance company that the paperwork was required.


When California long-term care insurance claims are denied, the policyholder and his or her family are left to ensure the senior is cared for, either by providing necessary care themselves or by paying for care that they thought was already covered with the policy. In some cases, this means family members must give up their jobs or their homes to move in with the policyholder when their claim for long-term care is denied.

California Long-Term Care Insurance Lawsuit

Various California lawsuits have been filed against long-term care insurance companies, alleging legitimate claims have been unfairly or reasonably denied, or claiming that insurance companies are only paying for part of the claim, deeming parts of the claim unnecessary.

Failure to pay out a legitimate claim could result in a bad faith insurance lawsuit filed against the long-term care insurance company. Some such lawsuits have resulted in settlements with long-term care insurance companies.

In addition, recently a California long term care lawsuit was filed in Los Angeles Superior Court against CalPERS on behalf of more than 125,000 long-term care policyholders. In the lawsuit, plaintiffs allege the pension fund misled beneficiaries by saying premium rates for the plan would be stable, However, in October 2012, CalPERS approved a plan to raise its long term care insurance premiums by 85% for hundreds of thousands of state workers and retirees.

According to the CalPERS lawsuit, the insurer failed to warn policyholders about any financial troubles it was having and the insurer admitted to taking part in an inappropriate investment strategy. The lawsuit seeks the return of all premiums paid by long term care insurance policyholders.



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Published on Oct-22-13


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