How do we get John Hancock to pay out for long term life insurance?

My grandma has paid $50,000 over the years for long term insurance though them and now that she needs a caregiver they are making us jump through a million hoops and refusing to pay. How do we force them to pay when we have done everything the right way?

Update:

My grandma has been seen by a john hancock medical representative and qualifies medically for a caregiver. That was not a problem. Her policy does cover an at home caregiver. Before we started with this care giving company we had them qualified. Now the insurance company stated that the caregivers do not qualify.

4 Answers

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  • Anonymous
    9 years ago
    Favorite Answer

    To comment and add on the answer below. That is correct the amount that is paid in does not matter, it is the benefit triggers, which are the same for all policy and the information below is correct.

    Before you contact an attorney I would first contact the insurance department of in your state, which you should be able to find easily online. If that doesn't work than you can go the route of contacting an attorney, but that is typically last resort and you should contact an elder care attorney.

    However, I know that John Hancock's claims paying rate is very high and the typical reason for an initial decline is that the insured does not fully qualify. For example may only need assistance with 1 activity of daily living instead of 2. One other reason is that your grandmother may not have met the elimination or waiting period, which is the amount of days care must be received in order for the benefits to start being paid. The typical elimination period is somewhere between 90-100 days, but can be as low as 30 or as high as 1 year.

    Hope this helps.

    Source(s): 12 years of industry experience with the first 3 years working for John Hancock directly.
  • 9 years ago

    1) It's called long term care insurance.

    2) If she qualified for a claim then they'd pay it.

    3) Just because she needs (or would like, or you would like) a caregiver doesn't mean that she qualifies for coverage. So, she likely needs a doctor to certify that she needs care, ongoing care, and that she's either unable to perform 2 out of 5 or 2 out of 6 (depending on when she bought the plan) activities of daily living.

    4) If she doesn't qualify then there's nothing you can do to get the policy to pay. It's pretty cut and dry.

  • 9 years ago

    First of all, this isn't "long term life", it's "long term care". The first thing you do, is sit down and read the policy.

    If you're sure she's GOT coverage for a caregiver in her home (not all policies will cover that, especially the older ones!!), AND she qualifies by not being able to perform enough "life functions", then you file a complaint in writing with your state insurance commissioner.

    Her legal guardian will have to be the person to do that.

  • Anonymous
    9 years ago

    The amount she's paid is irrelevant. The issue would be that she has paid current premiums and is in good standing.

    I take it you have already supplied them with one (preferably two) doctor's statements attesting that she cannot perform multiple daily functions without assistance *or* is a danger to herself and needs supervision at all times. If so, contact a lawyer as it it appears it is time to sue.

    Chronically Ill Individual

    A chronically ill individual is someone who has been certified (at least annually) by a licensed health care practitioner as—

    Being unable to perform at least two activities of daily living (eating, toileting, transferring, bathing, dressing, and continence), without substantial assistance from another individual, for at least 90 days, due to a loss of functional capacity, or

    Requiring substantial supervision to protect the individual from threats to health and safety due to severe cognitive impairment.

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