Fraudulent claims by long-term care insurance policyholders impact industry costs shares the director of the American Association for Long-Term Care Insurance (AALTCI), a national trade organization.
“The long-term care insurance industry paid claims last year in excess of $9.2 Billion to hundreds of thousands of individuals,” shared Jesse Slome, director of the national long-term care insurance organization. ”Included in the hundreds of thousands who legitimately have need are individuals making fraudulent claims something that impacts not just insurers but those who own or are considering buying this coverage.”
Slome was sharing industry updates with leading long-term care insurance agents. “I was pleased to see that New York Life was pursuing action against a North Carolina pastor who was paid $389,500 through her long-term care insurance policy but then was seen in Facebook photos performing activities contrary to her claim of severe and debilitating conditions.”
“Fraudulent long-term care claims are inevitable but the costs are inevitably passed on to honest customers and that’s why it is important to encourage and support greater vigilance and action,” Slome shared.
“Certain insurance carriers have become more aggressive in fighting fraud when they discover it,” explains Stephen Serfass, an attorney with Drinker Biddle & Reath LLP in Philadelphia, PA. “The fraud sometimes comes to light after the carrier has paid tens or hundreds of thousands of dollars in benefits.”
Slome encourage Association members to educate their clients and prospective buyers to the fact that insurers do pay claims, “One of the misperceptions held by many is that insurers deny claims or fail to pay them, something that is patently false,” Slome stated.
The organization is presently conducting a study of claims that will be published later this year. “We are hoping many of the top insurers will take the time to share information on this important topic.”
Consumers and insurance agents who want to learn more about long-term care insurance costs and planning options can call the American Association for Long-Term Care Insurance at 818-597-3227 or visit the organization’s website at www.aaltci.org to find and connect with local LTC insurance professionals.
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