Insurance company cheats seniors, lawsuit alleges

Source: Santa Monica Daily Press


Insurance company cheats seniors, lawsuit alleges

by Ashley Archibald
February 10, 2012

OCEAN PARK BLVD — Santa Monica-based protection advocates Consumer Watchdog filed a class action lawsuit Tuesday on behalf of an 87-year-old man and other elders they allege were bilked out of thousands of dollars by an insurance company in Pennsylvania.

Attorneys from Consumer Watchdog and the law firm of Shernoff Bidart Echeverria Bentley, LLP filed the lawsuit at the San Bernadino Superior Courthouse.

According to the suit, William Hall, of Upland, Calif., was allegedly cheated out of thousands of dollars by the Senior Health Insurance Company of Pennsylvania, or SHIP, which refused to honor the long-term care policy he had held with one interruption since 1994.

The suit charges that the company told policy holders that they needed to submit paperwork that was not required under their policies and when paperwork was submitted, did not acknowledge its receipt.

The claims are largely for in-home care services, caregivers that help old or infirm patients with daily tasks like dressing, bathing, eating and home chores.

Hall further alleged that when a claim was finally processed, it accounted for only 20 percent of what should have been covered.

"In simple terms, the goal of this lawsuit is to stop bad practices of this company and any company that picks on the elderly and gives them the run-around," said Bill Shernoff, an attorney on the case, during a press conference in Sunset Park.

Annette Gobrogge, a spokeswoman for SHIP, confirmed that the lawsuit had been filed and that the organization was looking into the complaint.

"SHIP focuses on ensuring that eligible claims are paid in accordance with the policy contracts that its customers have purchased, and operates without profit motive," Gobrogge wrote in an e-mail. "SHIP's sole mission is to pay eligible claims accurately and timely, and has established a very strong record of compliance."

The company is owned by a trust created by the Pennsylvania Insurance Department, and says on its website that "there is no profit motive."

According to the suit, Hall, a former chief of medicine at Kaiser Permanente hospital in Fontana, Calif. had repeated problems trying to get the company to pay claims.

Hall had paid over $20,000 in premiums since purchasing the insurance initially in 1994.

The lawsuit seeks to stop the company from requesting documents the plaintiff and his attorneys deem to be illegal under state law or unnecessary under the policy; respond to claims in a timely manner; to show clearly what is covered in benefit statements; keep records of documents submitted by policy holders and to allow policyholders to use any medical professional they choose to determine their eligibility benefits.

Furthermore, Hall is personally seeking damages for breach of contract, elder abuse and fraudulent business practices.

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