Maureen A. O'Kane, Nolan Tully, Author at LTCi Summit

Court Sides with Long-Term Care Insurer Over Claim Denial and Potential Fraud

A judge from the District of Colorado recently issued an opinion that might leave the door open for long-term care insurers to void policies after the contestability period expires if an insured commits fraud. See Meyer v. Mass. Mut. Life Ins. Co., No. 22-cv-2933, 2024 WL 2106452 (D. Colo. Apr. 26, 2024).

Though MassMutual initially approved Mr. Meyer’s claim in April 2018 after a psychologist determined that he had a severe cognitive impairment, MassMutual uncovered evidence in March 2020 during the benefits recertification process that suggested he was not severely cognitively impaired. MassMutual surveilled Mr. Meyer and recorded Mr. Meyer driving, shopping, carrying groceries, and walking unassisted. MassMutual ultimately terminated Mr. Meyer’s benefits in October 2020. Mr. Meyer then sued MassMutual for breach of contract and bad faith. MassMutual filed a counterclaim for fraud and, as part of the requested remedy, sought to invalidate Mr. Meyer’s policy for fraud in the claim process.

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Long-Term Care Insurance: Wellness Program Impacts on Claims and Health Outcomes

Insurance partner Nolan Tully and associate Jamie Campisi recently coauthored an article for LexisNexis Practical Guidance that discusses how wellness programs can be used to potentially prevent, delay or lower the severity of long-term care claims and improve health outcomes.

They give an overview of the wellness programs, noting that they are largely focused on pre-insurance-claim intervention but that services can be provided to healthy, at-risk and on-claim populations alike. Nolan and Jamie provide examples of wellness initiatives, including engagement initiatives, support wellness interventions and care wellness programs.

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Highlights from the LTCi EX Task Force Meeting at NAIC

We want to bring you some highlights from the in-person LTCi EX Task Force meeting we attended August 12 during NAIC’s Summer National Meeting in Portland. The Commissioners principally discussed the next steps in the rollout of the Multistate Actuarial (MSA) Framework and the results of a survey of financial advisors to help the Task Force understand how policyholders are considering rate increase communications and the accompanying reduced benefit options that the rate increase communications include.

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Other States Slow to Follow Florida’s Lead on Genetic Information Restrictions

With the widespread availability of genetic testing, especially in direct-to-consumer forms, there is a growing concern about the privacy of that information and whether it can be used by insurers to underwrite policies for certain lines of insurance. Federal law provides a base amount of protection through the Genetic Information Nondiscrimination Act (GINA), which prohibits discrimination based on genetic information in both the health insurance and employment context. However, GINA does not apply to life, disability or long-term care insurance. With such limited federal protections, individual states are left to provide greater protections if they wish to.

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NAIC’s Long-Term Care Insurance Multistate Rate Review (EX) Subgroup Releases New MSA Framework Draft

NAIC’s Long-Term Care Insurance Multistate Rate Review (EX) Subgroup recently released a new draft of its MSA Framework document. Comments are due by December 6.

The NAIC has charged the Long‐Term Care Insurance (EX) Task Force with developing a consistent national approach for reviewing current LTCi rates that results in actuarially appropriate increases being granted by the states in a timely manner and that eliminates cross‐state rate subsidization.

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The NAIC LTCi Reduced Benefit Options Subgroup Reports on Potential Issues Related to LTC Wellness Benefits

On July 22, 2021, the NAIC Long-Term Care Insurance Reduced Benefit Options (EX) Subgroup, led by Commissioner Altman (PA), posted its first draft of a discussion paper Issues Related to LTC Wellness Benefits online. Comments are due September 5, 2021.

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Updates to the Long-Term Care Insurance NAIC Model Act and Model Regulation

As part of its effort to revamp and modernize the Model Laws, the National Association of Insurance Commissioners (NAIC) is updating the Long-Term Care Insurance Model Act, Model 640-1, and the Long-Term Care Insurance Model Regulation, Model 641-1 (combined, the Models). The current versions of the Models were finalized in 2017, and all states have adopted the current Models or similar legislation.

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Examining the State of the Long-Term Care Insurance Hybrid Market

Join us June 30 for a discussion about the current state of the LTCi hybrid market and its future. Cheri McCourt, assistant general counsel at Northwestern Mutual, will join partners Sandy Jones and Nolan Tully to share their insights on LTCi hybrid issues including:

A market shift towards brisk sales of hybrid products and away from stand-alone LTCi
Key features of LTCi hybrid products and related legal/regulatory considerations
The future of the LTCi hybrid market, including:

Can products be designed to reach the middle market?
Can this product fill the LTC funding gap or even reduce population-wide reliance on Medicaid for LTC?
Are there products or features that could enhance the usefulness of hybrid products by, for instance, introducing wellness incentives for policyholders?

Litigation risks to riders/hybrids connected with sales and product confusion

To learn more and to register click here.