Connecticut Continental Casualty Long Term Care Insurance Settlement

A proposed $2.75 million settlement has been reached between Continental Casualty Insurance and policyholders who allege CNA acted in bad faith by denying the coverage of long term care benefits of the elderly.

The settlement resolves claims stemming from a class action lawsuit that alleges CNA wrongly denied certain claims for stays in Connecticut MRCs in which Assisted Living Services Agencies provide services to residents.

The estate of 91-year plaintiff Marie Gardner, a policyholder of CNA, living in an assisted living facility, claims CNA improperly denied benefits from her long term care policy – a policy for which she had been paying premiums on for over 15 years. Prior to her death, Gardner filed her complaint in December 2013, after she fractured her hip.

According to the CNA long term care benefits class action lawsuit, CNA denied the long term care claim on the grounds that MRCs were not licensed by the state and cannot and did not provide the level of care and services required by the policy for coverage.

Allegedly, CNA claimed benefits covered only assisted living facilities with a nurse on the premises 24 hours a day. Gardner submitted a claim a few years prior where she was able to receive benefits while at the same assisted living facility. CNA reportedly denied Gardner’s claim once her condition improved slightly.

The plaintiffs believe these claims should not have been denied and should have been paid.

CNA denies any wrongdoing and contends that it complied with all laws and other requirements in connection with these policies. CNA also says that any and all coverage denials were correct under the terms of the policies.

Class Members who wish to be excluded from or object to the settlement must do so by Jan. 27, 2017.

Who’s Eligible

The Settlement Class “includes all CNA policyholders with the Policies listed below that were issued in Connecticut and (1) who made a claim under a policy relating to a stay in a managed residential community (‘MRC’) in the State of Connecticut; (2) who were medically eligible for benefits; (3) but were not afforded coverage for the costs and expenses relating to the stay; (4) on the grounds that the facility (a) was not licensed by the state and/or (b) could not legally provide 24-hour-a-day, or continuous nursing services/care and/or (c) did not provide daily medical records, (5) who was not denied coverage for any other reason, and (6) who suffered ascertainable damages as a result of being denied coverage.”

If you are not sure whether you are included in the Class, contact Class Counsel at 1-855-693-9256.

Potential Award

Varies.

The settlement provides for cash payment of 80 percent of the daily facility benefit for claims that were submitted in writing to CNA and/or denied by CNA in writing that fall within three benefit categories. These benefits are applicable to each covered day of stays at an MRC (in the case of Category One and Category Two) or a private residence (in the case of Category Three) from Dec. 27, 2007 through Mar. 31, 2016.

Category One: To be entitled to the Category One benefit, the Class Member must have actually resided in an MRC and must have paid for and received “Qualified Care” from an on-site ALSA. This benefit is paid only for days in which the Class Member actually resided in an MRC while receiving Qualified Care from an on-site ALSA.

Category Two: To be entitled to the Category Two benefit, the Class Member must have actually resided in an MRC and must have paid for and received “Qualified Care” but need not have received the care from an on-site ALSA. The Class Member must, however, have paid for and received Qualified Care from a third party provider while residing in the MRC. This benefit shall be paid only for days in which the Class Member actually resided in an MRC while receiving Qualified Care from a third party provider.

Category Three: To be entitled to the Category Three benefit, the Class Member must have resided in a private residence (e.g., your home) after the claim for a stay in an MRC was denied. To qualify for the Category Three benefit, the Class Member must have paid for and received Qualified Care from a third party provider following the denial. This benefit shall be paid only for days in which the Class Member actually resided at home while receiving Qualified Care.

Note: For claims qualifying under Category One, Category Two or Category Three, Class Members should receive cash reimbursement of 80 percent of the premiums paid that would have been waived during the above stays if the claim(s) had originally been approved (“Waiver of Premium Benefit”).

Claims that would qualify under Category One, except that the Class Member did not file a claim in writing and did not receive a claim denial in writing, can receive 50 percent of their policy’s daily facility benefit, and 50 percent of the Waiver of Premium Benefit, for every day they:

• Resided in an MRC from Dec. 27, 2007 through Mar. 31, 2016 while paying for and receiving Qualified Care; or
• Resided in a private residence from Dec. 27, 2007 through Mar. 31, 2016 while paying for and receiving Qualified Care

“Qualified Care” means:

• Skilled nursing or intermediate nursing care – which is medical care above the level of assistance with the activities of daily living – at least three times a week; or
• One of the following activities of daily living, with the frequency as indicated: Bathing (at least three times a week), dressing (at least five times a week), transferring (at least once a day), eating (at least once a day), incontinence care (at least once a day), medication (at least three times a week), mobility (at least once a day), or toileting (at least once a day); or
• Confinement in a locked or lockable memory care or dementia unit serving patients who are elopement risks with regular assistance.

Care provided by friends or family members of any kind is not included.

The total of all payments to be made to all Class Members pursuant to these benefits will be capped at $2.75 million. To the extent that the amount of approvable claims to all Class Members exceeds the $2.75 million cap, the approvable claims submitted by the Class Members shall be reduced proportionately by the percentage necessary to bring the total of all payments for approvable claims within the $2.75 million payment cap.

Proof of Purchase

All claims (whether in Category One, Two, or Three) must be supported with documentation evidencing days of, types of, and payments for services. CNA may have some of this information already in its possession but it is the Class Member’s responsibility to compile information to support the claim.

Category Two claims must be supported with:

• Documentation of payment for care received while residing in the MRC from a third party provider (e.g., bank statements, cancelled checks, receipts)
• A sworn statement demonstrating that the provider’s daily or monthly cost from the third party provider was lower than the daily or monthly cost of the Assisted Living Services Agency (ALSA)
• A sworn statement confirming that the Class I Member would have engaged the ALSA if CNA had approved rather than denied the claim, but engaged the third party provider because of the claim denial and because it was less expensive than the ALSA.

Category Three claims must be supported with:

• Documentation of payment for care received while residing in a private residence from a third party care provider (e.g., bank statements, cancelled checks, receipts)
• A sworn statement averring that the Class I Member would have stayed at the MRC and engaged the ALSA to provide care if CNA had approved the claim but instead moved to/remained in a private residence and engaged the third party care provider only because of the claim denial and because it was less expensive than remaining at the MRC and paying the MRC and ALSA

Category One claims where the Class Member did not file a claim in writing and was advised orally that a claim for coverage of an MRC stay would be denied must also be supported with a sworn statement averring that he or she was personally told by CNA or its claim representative on the telephone that MRCs were not covered under his or her policy and did not make a written claim for that reason.

Draft sworn statements can be found on the settlement website.

Claim Form

CLICK HERE TO FILE A CLAIM »

Claim Form Deadline

2/20/2017

Case Name

Gardner, et. al. v. Continental Casualty Company, Case No. 3:13-cv-01918-JBA, in the U.S. District Court for the District of Connecticut

Final Hearing

2/28/2017

Settlement Website

www.CTLongTermCareInsuranceSettlement.com

Claims Administrator

Gardner v. Continental Casualty Co. Settlement
c/o KCC, Settlement Administrator
P.O. Box 8060
San Rafael, CA 94912-8060
1-888-251-7042

Class Counsel

Jeffrey S. Goldenberg
Todd B. Naylor
GOLDENBERG SCHNEIDER LPA

Sean K. Collins
SEAN K. COLLINS, ATTORNEY AT LAW

Lionel Z. Glancy
Ex Kano S. Sams II
Kara M. Wolke
GLANCY PRONGAY & MURRAY LLP

Janet E. Pecquet
BECKMAN WEIL SHEPARDSON LLC

Defense Counsel

Brent R. Austin
R. John Street
Ameri R. Klafeta
EIMER STAHL LLP