Woman denied coverage after paying premiums for 20+ years | MCUTimes

Woman denied coverage after paying premiums for 20+ years

You think you are doing the right thing by planning your future. But a Deer Park family learns that long-term care insurance is not the safety net they thought it was. KPRC 2 Investigates helps a viewer look for answers as to why his mother cannot get the help she needs. Plus, we have everything you need to know about researching insurance companies and what you need to know before buying a new policy.

Denied care insurance

Viewer Jeff Yates contacted us for help figuring out * why * his mother was denied home health care because of a long-term care she has been paying for more than 20 years. Mary Yates has always been independent, but as an 83-year-old and had recovered from a broken pelvis, she now needs help with everyday things.

A former high school principal, Mary has always been a planner, so she thought she was preparing for this phase of her life decades ago.

“When I retired, I thought, well, the next step is mine, my care when I’m older,” Mary explains. “And then I thought it was taking long-term care.”


She has paid her monthly premiums without error. Right now, she pays $ 540 a month for Jackson National Life Insurance. But Mary and her son Jeff were shocked to learn that her life insurance policy says she is not eligible for home health care.

According to the policy, Mary says she does.

“It’s everyday activities that you can not, if you can not perform them, you qualify for care,” Mary said.

Why were Mary’s long-term insurance claims denied?

A spokesman for Jackson told us that the claim was rejected because – citing “there is no evidence that the applicant’s claim for benefits met the conditions and conditions of coverage as described in the policy.”

“Apparently they do not believe she is, she needs this home care that she has paid for over the last 21 years,” Jeff said.

Mary first bought the policy from the USAA, but it has changed hands over the years.

And people who complained to the Better Business Bureau about Jackson also say they did not choose the company.


“I’ve seen a lot of people in their complaint reviews say you know it used to be this, and then that name changed, or my insurance company sold all their contracts for this to Jackson this company,” Ashley Gibbard explains, Better Business Bureau.

Jackson has one out of five stars with BBB.

“I’m so disappointed with this company,” Mary said. “Let us not give our senior citizens a terrible time when they are at their lowest. Let us endure the conclusion of your agreement that we entered into. ”

A Jackson National representative says Mary can appeal the decision. The Yates family says they receive a letter from Mary’s doctor confirming that she is chronically ill before appealing.


Resources in connection with care insurance

Texas Department of Insurance

NICB | National Insurance Crime Bureau

What to see for when shopping for long-term care insurance

Texas The insurance department

Full statement from Jackson National regarding Mary Yates’ claim

“The claim was rejected due to the fact that there is no evidence that the applicant’s request for benefits met the conditions and provisions for coverage as described in the policy. The plaintiff has been informed that if no additional documentation or medical records have been submitted that could previously substantiate the claim, Jackson will gladly reconsider the denial. ”

Jackson spokesman

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