PORTLAND, Ore.--(BUSINESS WIRE)--Many elderly Oregonians in need of nursing home or other assisted care are finding they have no help when they need it most. Law firm Williams Love O’Leary & Powers alleges Bankers Life and Casualty, a Chicago-based firm, is denying benefits to those who paid for long term health care insurance so they would have security in their old age. A class action lawsuit against the insurance company was filed today in U.S. District Court in Portland.
“My mother trusted this company,” Grants Pass resident Dennis Fallow explained at a Portland news conference this morning. “She paid their premiums for years, counting on having support if she became ill. That time came and all she got from Bankers Life was a cold shoulder, rejection and red tape. It was a total rip off.”
Fallow’s 79-year-old mother, Katherine Fallow, needed an in-home caregiver when she came home in 2009 following multiple hospitalizations. The family hired a caregiver certified as a home health aide by the State of Washington and an Oregon certified home health aide to care for Mrs. Fallow. Dennis Fallow began submitting the bills for that care to Bankers Life, anticipating payment under terms of his mother’s policy. What followed were several months of wrangling over aides’ qualifications, long delays in communications and denials of payments. Bankers Life eventually made payments in the amount of $11,388, far short of the $51,667 the family paid for Mrs. Fallow’s care. Mrs. Fallow died on July 6, 2011.
In 2011, Grants Pass attorney Christopher Cauble filed a lawsuit against Bankers Life on behalf of the Fallows. He soon learned the Grants Pass family wasn’t alone.
“Bankers Life has likely refused long term health care benefits to many, many Oregonians,” Cauble told reporters. “I began hearing about other families with experiences similar to that of the Fallows. What we have in Bankers Life is a company with a history of raising premiums, delaying payments and denying legitimate claims.”
Cauble’s findings prompted him to join with Portland attorney Mike Williams and his firm to file the federal class action against Bankers Life on behalf of all Oregon consumers. That lawsuit was the one filed in Portland today. Four individuals (two harmed families) have made claims as representatives of the class. Cauble and Williams estimate there are hundreds, perhaps thousands, more elderly Oregonians and their families who could join the suit. The Oregon action is similar to other lawsuits against Bankers Life in other states.
“This is a company that preys on people when they are at their most vulnerable,” said Williams. “When you’re weak and sick, at the end of life, that’s when you need the benefits. Bankers Life stalls and refuses to pay. The company is counting on you not having the energy or ability to fight back. Many people don’t. And, of those who do, many still don’t get paid. That’s how the company makes its money. It is a classic consumer scam aimed at the most vulnerable people.”
In 2011, Bankers Life ranked worst (19th out of 19 companies) in the Oregon Department of Consumer and Business Services’ (DCBS) consumer complaint index. In fact, DCBS figures show Bankers Life ranked worst for consumer complaints every year from 2005 to 2011.
DCBS reports that Oregonians held 91,545 long term care policies in 2011. That’s six percent of residents age 46 and older. People buy the insurance as a safeguard for their old age, to help pay medical expenses and diminish the costs of care providers at home or in assisted living facilities and nursing homes. In 2011, Bankers Life accounted for 10 percent of this market. Bankers Life documents, obtained in the Fallow case, show the company receives about 350 claims each month from Oregonians.
Cauble and Williams drew attention to a 2008 multi-state investigation into consumer complaints against Conseco, Inc., the parent company of Bankers Life. That action resulted in a settlement and agreement with Conseco that included a $2.3 million fine and $30 million in claims-handling improvements and restitution by the company. Oregon was not part of that multi-state action. In November 2012, the involved states found that Bankers Life was not complying with the terms of the 2008 settlement and another $3.2 million penalty was levied against it.
The named representatives of the Oregon class action are Lorraine Bates and her husband Ehrman Bates, both of La Grande, Ore.; and Eileen Burk, of Sherwood, Ore., and her son David Youngbluth, of Prineville, Ore.