Litigation Archives - 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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2024 Intercompany Long-Term Care Insurance Conference

Faegre Drinker is delighted to sponsor and speak at the 2024 Intercompany Long-Term Care Insurance (ILTCI) Conference, coming up March 17-20 in San Diego. This annual event draws hundreds of attendees from insurance, financial, and other business sectors, and serves as a platform fostering collaboration among insurance regulatory authorities, educational institutes, actuaries, and others with interest in long-term and extended care insurance. We look forward to seeing you in San Diego!

During the conference, Faegre Drinker will be well represented by members of our LTCi team who will be speaking on the following topics:

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See You Soon! ILTCI 2023 Annual Conference

In just over a week, members of Faegre Drinker’s LTCi team will attend the 2023 Intercompany Long Term Care Insurance Conference in Denver. We are proud to once again support ILTCI as a diamond-level sponsor of the conference and our team will be presenting on a number of panels throughout the Conference. We look forward to connecting with our colleagues and friends throughout the industry. Make sure to check out our team members on the following panels!

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Faegre Drinker Long-Term Care Summit V Recap

Faegre Drinker held its fifth Long-Term Care Insurance Summit in Chicago this fall. The event kicked off on October 18 with an informal, fun, and engaging social get-together, while the overall format for the interactive meeting was selective, informative, and fast-moving. Carrol Golden, Executive Director of the Specialty Centers at the National Association of Insurance and Financial Advisors (NAIFA), shares a recap of the event.

The first day, Faegre Drinker Partner Steve Serfass shared welcome remarks and introduced Peter Lucas, CEO of Davies, and John Sieb, Business Head and COO – Long Term Care at Prudential and invited them to share their views about the most significant issues and opportunities facing the LTCi community today. Peter urged that while embracing new concepts and insights, the industry should not lose focus on the basics of good policy and claim administration, and he also addressed the importance of creating attractive career paths and opportunities for young and mid-level professionals while mentoring them to become the next generation of leaders. As he discussed the importance of proactive block management, John stressed three strategic pillars: data and analytics, digital TP and claims management.

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Artificial Intelligence Briefing: FTC to Address Commercial Surveillance and Data Security

From time to time, colleagues in our larger Insurance practice, along with other non-insurance-related practices, write on issues that we feel are important enough to highlight on this blog. Emerging attention to Artificial Intelligence (AI) by lawmakers and regulators alike is one such issue. Among the topics highlighted in Faegre Drinker’s latest Artificial Intelligence Briefing is the Collaboration Forum on Algorithmic Bias held during NAIC’s Summer Annual meeting that featured various presentations, including one from our own Scott Kosnoff on how companies can mitigate their regulatory, litigation and reputation risk through AI risk management and governance.

Long-Term Care Insurance Fraud, Waste, and Abuse: A discussion with Karen Smyth and Jeff Ferrand

Industry stalwarts Karen Smyth (Vice President of Long Term Care Operations at Wilton Re) and Jeff Ferrand (Vice President of Fraud Services at LTCG) have significant experience developing and implementing anti-fraud, waste, and abuse programs at the carrier and TPA level.

Please listen to the below podcast with Chris Petillo and Jessica Loesing as they discuss Karen’s and Jeff’s views on, among other questions, how fraud, waste, and abuse manifest in the LTCi space, and potential efforts carriers and TPAs can use to prevent and detect fraud, waste, and abuse. Karen also shares her experience as a witness in a criminal trial involving LTCi insurance fraud and Jeff shares his past experience as outside counsel prosecuting insurance fraud cases. Finally, stick around to hear some of the creative and industrious ways Karen and Jeff have been passing the time with their families (at home) during the pandemic.

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Recent Developments in LTC Rate Increase Litigation

A relatively consistent flow of premium rate increase litigation has been filed against long-term care (LTC) carriers over the past several years. Following the plaintiffs’ bar having early success in a limited number of LTC rate increase class actions in the early 2000s, the tide turned definitively in favor of carriers in what we think of as the first generation of such litigation, where the plaintiffs’ bar focused primarily on an alleged duty to disclose possible rate increases and challenging the language of the contract itself. Despite the industry’s overall success, premium rate increase litigation has attracted an increased level of sophistication from the plaintiffs’ bar, which shifted to more creative theories based on extra-contractual representations (e.g., marketing materials) in what we view as the second generation of premium rate increase litigation. While the industry remains mostly successful in warding off rate increase litigation, a new trend may be developing as recent cases focus on more nuanced contractual limitations and rate increase implementation issues.

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Responding and Managing the Impact of COVID-19

Assured Allies and Faegre Drinker have partnered to develop a playbook for the long-term care insurance industry. Responding and Managing the Impact of COVID-19 offers insights, guidance and ideas to manage the short- and medium-term impacts of the COVID-19 global pandemic and provides potential avenues for long-term care insurers to explore in the post-COVID-19 world that could change long-term care insurance forever.

Category: Litigation