This lawsuit alleges that John Hancock Life Insurance Company unlawfully denied coverage or delayed payment for nursing home room and board expenses to Long Term Care Insurance policy holders, in violation of New Jersey law.
Grace L. McElwee, an 89 year old New Jersey resident, purchased a Long Term Care Insurance policy from John Hancock Life Insurance Company (Hancock) in 2002 for coverage in the event she became in need of “Substantial Assistance” in performing “Activities of Daily Living” or suffered from “Cognitive Impairment”, with coverage to be triggered 100 days after the insured begins receiving such services in a nursing home or assisted living facility. McElwee claims she became in need of “Substantial Assistance with Activities of Daily Living” and was “Cognitively Impaired” on November 6, 2012 while she was confined at a “nursing home” and at an “assisted living facility,” making February 5, 2013 the date she would qualify for policy coverage. Later, in the Fall of 2014 while residing at an assisted care living facility, McElwee fractured her leg and was eventually discharged to an assisted living facility.
According to McElwee, her John Hancock long term care insurance policy defines “nursing care” and “custodial care” ordered by a physician as “including room and board” at qualified facilities and therefore, her “room and board” expenses constitute a compensable component of “Assisted Care Living” costs. John Hancock has refused to pay McElwee for her room and board and other non-exempt expenses while she is “confined” to both “Nursing Home” and “Assisted Care Living” facilities allegedly because according to her policy terms and definitions, she had already been receiving room and board from the facility before she was “confined” (due to “cognitive impairment” or being in need of “substantial assistance with daily living”) to either a nursing home or assisted living facility. John Hancock is also alleged to have denied coverage after her 2014 fracture, representing that since McElwee received Medicare payments after her fall, she is not entitled to payments under the policy.
In February 2015, McElwee’s son, Andrew A. McElwee, Jr., Esq., filed a class action suit in New Jersey Superior Court (Somerset County Law Division) on her behalf and as representative of other long term care policy holders who reside in “nursing homes” or “assisted care living facilities” who have been denied coverage of “room and board” expenses. The suit alleges John Hancock breached its contractual duty to McElwee and other policy holders by discriminating between an insured who paid room and board directly to a vendor and an insured who paid room and board to a facility as a component of all charges.
The class action claim seeks compensatory and punitive damages for policy holders for John Hancock’s alleged deceptive practices or deliberate misinterpretation of policy coverage and benefits to avoid paying claims. The lawsuit also seeks to represent individuals who were denied claims for long term care expenses that were alleged to be covered by Medicare and those who have been denied or delayed all or a portion of payments due to bad faith practices of John Hancock.
Article Type: LawsuitTopic: Consumer
Most Recent Case Event
John Hancock Long Term Care Insurance Class Action Room and Board Denial Complaint
February 5, 2015
The complaint for this class action alleges that the John Hancock Life Insurance Company unlawfully denied coverage or delayed payment for nursing home room and board expenses to long term care insurance policy holders, in violation of New Jersey law.
john_hancock_long_term_care_complaint.pdfCase Event History
John Hancock Long Term Care Insurance Class Action Room and Board Denial Complaint
February 5, 2015
The complaint for this class action alleges that the John Hancock Life Insurance Company unlawfully denied coverage or delayed payment for nursing home room and board expenses to long term care insurance policy holders, in violation of New Jersey law.
john_hancock_long_term_care_complaint.pdf