September 17, 2013 -- U.S. Magistrate Judge Mark Clarke ruled Thursday (9/12/13) that Bankers Life must pay Grants Pass resident Dennis Fallow $50,000 for legal fees and court costs in his lawsuit against the Chicago-based issuer of long term care policies. The ruling came in Fallow’s lawsuit against Bankers Life in U.S. District Court in Medford. Fallow filed suit against Bankers Life in 2011 on behalf of his mother, Katherine Fallow, a holder of a Bankers Life policy. Earlier this year, Magistrate Clarke ordered Bankers Life to pay $40,230 for long term care insurance claims owed to Ms. Fallow and her family.
“What’s important about the judge’s decision,” said Chris Cauble, the Grants Pass attorney who represents Fallow, “is it sets a standard for other Oregonians who are paying Bankers Life premiums and are unfairly denied payment of their claims. We have a ways to go in pressing our case, but this is definitely a positive step in the right direction.”
In representing Fallow, Cauble learned that many other policy holders, all elderly, were having difficulty receiving payments from Bankers Life. Cauble, with Portland attorneys Mike Williams and Leslie O’Leary, filed a class action lawsuit on April 4, 2013 against Bankers Life on behalf of all Oregon policy holders. The class action contends the company is unfairly denying benefits to those who paid for long term health care insurance to give them security in their old age. Of course, the denials come right at the time when the policy holders are at their most vulnerable and in greatest need of care.
To date, 37 Oregonians have signed on to the class action. If the case is certified, it would apply to all Bankers Life policy holders in Oregon. The next hearing in the case is scheduled for October 16, 2013. The class action attorneys estimate there are some 9,000 Oregonians who hold Bankers Life long term care policies.
Katherine Fallow died in Grants Pass in 2011 at the age of 82. For several months prior to her death, she needed an in-home caregiver. 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 Ms. Fallow. Dennis Fallow began submitting 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 some payments. However, those payments fell far short of the thousands the family paid for Ms. Fallow’s care.
Attorney Cauble called Bankers Life a company “with a history of raising premiums, delaying payments and denying legitimate claims.”
In 2012, Bankers Life ranked worst (20th out of 20 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 2012.
People buy long term care 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.
Bankers Life is appealing the court’s rulings in the Fallow case.
