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Originally Posted by BirdDancer
Thank you so much, Wild Coyote, for all of this helpful information.  I will share this with my sister. So you know, we do plan to hire a lawyer to help with a number of matters regarding my father. I will be sure we bring up this topic to the lawyer, as well, and see if he can help us with it or if we should pursue it on our own.
I believe it was the LTC insurance's assumption that our Dad's injuries were as a result of alcohol. Even some of the doctors at the hospitals he was in were saying this, but honestly I am not so sure this is the case. Hopefully the neurologist and psychiatrist my father will go to in a couple of weeks will have proper insight into this.
I can't be sure if the alcohol affected him cognitively or if his cognitive and psychiatric state were the culprits. My husband and I even believe his heavy drinking was not so much the cause of everything, but a symptom of life-long psychiatric issues and perhaps early stages of some neurological issue(s). You know...Which came first? The chicken or the egg? To my knowledge, my father's drinking issues did not even start until he was in his early 60s. The worst of it didn't even start until he was already in his 70s. I find that abnormal when it comes to addiction. That is something I wish to bring up in the letter I write. So often when there is addiction, it is portrayed as if it's been a lifelong problem. |
Hi BirdDancer,
I've had incredibly great outcomes with any insurance matter (health, auto, home) when I had brought disputes with them to the attention of the Banking and Insurance Commissioner/Ombudsmen. I have done so in 3 different states and for different types of insurance. In every case, the insurer was remiss and they had to step up and pay up. (Just one case was one in which my insurer had to pay a $53,000.00 hospital bill. They also had to pay my deductibles and my co-pays for my trouble.)
If consumers feel comfortable doing so, they can represent themselves in the the process. The ombudsman is an advocate. Depending on the intensity of the process and what's at stake, some may want to defer to additional legal advice/representation.
I understand how many doctors do tend to blame everything on a person's "problem list" or every illness is resulting from alcohol. I went through this with one of my brothers. It was horrible. He was critically ill in a university hospital. I was his health Power of Attorney/advocate. His primary care doctor had blamed absolutely everything upon his alcoholism. I kept debating the PC . He was wrong, very wrong! (My brother passed away because his PC doctor failed to recognize something more serious was taking place and never ordered the appropriate scans/tests. It was serious enough that the PC was banned from practicing at that hospital.)
A close friend's mother had started showing signs of dementia and within 2 years, her mom needed more care than she could provide. Her mom had a LTC policy. She had been admitted to a nursing home, It was a nightmare! The company tried to find all kinds of reasons as to why the didn't have to pay a cent. With the help of an attorney, the insurance company had started payment of her medical bills. The mother was then severely abused in the nursing home. She was transferred to a different nursing home. There were abuse issues there, too.
My friend then took her mom back home with her and hired help at home. (My friend owns/manages a very busy business and could not care for her mom 24/7.) The LTC insurer would not pay on the home care benefits outlined in her mom's policy. Another legal inquiry caused the insurer to pay up. I saw in the guide book ( a link in the info I'd posted here) that many LTC policies include some care at home. I've mentioned this story incase your dad has some home care benefits. Just wanted to say that if the benefits are outlined in his policy and the insurer fails to pay, someone should be able to force them to honor the provisions in the policy and in any policy riders.
It can help a great deal to know there are people who will investigate and will force the difficult insurers to fully honor the policies they have sold to our elderly. Banking and Insurance Commissioners Offices/Staff are there to police the insurance companies and the banks.
Insurance Commissioners generally frighten insurance companies simply by contacting them and notifying them of a pending investigation. Insurers usually then do honor their policies. An Insurance Commissioner can remove any insurance company from legally operating in the state if an insurer fails to honor the coverage promised to the policy holder(s).
I hope things go well for you and for your loved ones.
Love and Prayers ~
