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December 2014 Archives

Long-term care insurance: Tips when coverage fails

Setting aside money for retirement is just one step towards future financial security. In addition to funding retirement savings, a long-term care insurance policy may provide additional protection in the event of debilitating illness. This form of insurance is designed to afford protection against the expenses of long-term care in the home or in a nursing home or facility. Such policies generally provide reimbursement for the costs of care for assistance in bathing, dressing or eating. Policies vary in the amount of costs reimbursed, the scope of services that are covered, and the duration of payment; and premiums are subject to change as long-term care costs increase.

7th Circuit hears oral argument on discretionary clause ban

On December 1, 2014, the U.S. Court of Appeals heard oral argument in the case of Mary C. Fontaine v. Metropolitan Life Insurance Company.  The issue before the court was whether an Illinois insurance regulation banning discretionary clauses in health and disability insurance policies survives ERISA preemption claims.  The lower court ruled in Fontaine's favor. 

Job versus Occupation

In evaluating occupational disability claims, insurers distinguish between the insured's job and their occupation.  If an employee cannot perform their job, they may still be denied disability insurance benefits if they remain capable of performing their occupation as it is generally performed in the national economy.  Polnicky v. Liberty Life Assur.Co. of Boston, 2014 WL 6680725, 2014 U.S.Dist.LEXIS 164890 (N.D.Cal. November 25, 2014) is an illustration of this issue.  There, a mortgage broker employed by Wells Fargo   claimed he was no longer able to make calls upon realtors and customers due to a spine impairment. However, the insurance company insisted that the occupation of "sales representative, financial services" could be performed within the bank while seated at a desk.  The court disagreed.

DeBofsky, Sherman & Casciari, PC