John Hancock Hit With Long-Term Care Coverage Class Action

John Hancock faces a putative class action lawsuit over allegations that the life insurance company refused to pay room and board fees that should have been covered under a long-term care insurance policy.

The John Hancock class action lawsuit was filed Tuesday on behalf of plaintiff Grace McElwee of New Jersey who is represented by her son Andrew McElwee Jr. because she is no longer capable of handling her affairs on her own.

According to the John Hancock insurance class action lawsuit, Grace McElwee purchased a long-term care insurance policy in 2002 just in case she eventually became in need of “substantial assistance.” Since purchasing the policy, the plaintiff has reportedly paid more than $83,000 to John Hancock.

Under the terms of her John Hancock care policy, both nursing care and custodial care charges are covered after 100 days of being declared to need “substantial assistance” with everyday activities or cognitively impaired. 
The John Hancock class action lawsuit claims that the insurance company expressly states that room and board charges are covered under the long-term care policy.

According to the class action lawsuit, “nursing care” is defined by John Hancock as services performed by or under the continual, direct and immediate supervision of a registered nurse on-site for 24 hours per day at a facility which is “licensed or certified and operated to provide nursing care for a charge (including room and board).”

In 2012, McElwee allegedly became in need of assistance with daily living while she was confined in a nursing home and an assisted care living facility where she received nursing care and custodial care. The John Hancock insurance class action lawsuit claims that the company is required to pay for McElwee’s nursing and custodial care charges including room and board but has refused to do so.

According to the John Hancock class action lawsuit, in 2014 while residing at an assisted care facility McElwee fell and fractured her leg. Since the accident John Hancock has allegedly refused to pay any portion of her nursing home or assisted care living charges verbally stating that because she received Medicare payments since her fall, she is not entitled to any payments under their policy.

The John Hancock insurance class action lawsuit claims that the company did not provide any breakdown of charges covered by Medicare making it “impossible” to determine if McElwee received the insurance benefits for which she is entitled.

McElwee is suing John Hancock for breach of contract and bad faith practices alleging that the insurance company deliberately misinterprets records or policy language so they can avoid coverage.

If approved, the John Hancock insurance class action lawsuit would be open to all New Jersey residents who have been denied coverage for room and board expenses with respect to John Hancock’s plan for long-term health insurance. The John Hancock class action lawsuit also seeks to represent individuals who have been improperly denied claims for long-term care charges that were allegedly covered by Medicare and those who have been denied all or a portion of their right to payment or have received delayed payments as a result of John Hancock’s bad faith practices.

McElwee is represented by Kenneth L. McElwee.

The John Hancock Insurance Coverage Class Action Lawsuit is McElwee v. John Hancock Life Insurance, Case No. 3:15-cv-07398, in the U.S. District Court for the District of New Jersey.