Consumer Watchdog has filed a lawsuit alleging that Senior Health Insurance Company of Pennsylvania avoided paying in-home health care claims for elderly Californians, the AP/San Francisco Chronicle reports.
The consumer advocacy group filed the lawsuit -- which seeks class-action status -- in San Bernardino County Superior Court on Tuesday.
SHIP has about 10,000 policyholders in California.
Background
In 2009, the insurer agreed to pay $500,000 to settle a lawsuit filed by California regulators alleging that it had improperly denied claims on long-term care policies and that its processes for handling claims were confusing and burdensome.
Details of New Lawsuit
The Consumer Watchdog lawsuit was filed on behalf of 78-year-old William Hall, who bought a SHIP policy in 1994 and submitted claims in 2010. The insurer reimbursed only 20% of his expenses.
The lawsuit alleges that SHIP:
- Attempted to avoid reimbursing policyholders for long-term care by ignoring claims or taking an unreasonably long time to respond to them;
- Required unnecessary medical examinations and paperwork; and
- Required caregivers to have licenses in violation of company policy and state law (AP/San Francisco Chronicle, 2/8).
The insurer has not yet responded to the lawsuit (Jahad, "KPCC News," KPCC, 2/8).