Mar 24

Class Certified in Case Against LTC Insurer that Denied Coverage to Assisted Living Residents

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A U.S. district court in Connecticut certifies a class action against a long-term care insurance company by policyholders who claim they were unfairly denied coverage because they lived in a managed care community or assisted living facility. Gardner v. Continental Casualty Company (U.S. Dist. Ct., D. Conn., No. 3:13cv1918 (JBA), March 1, 2016).

A group of individuals purchased long-term care insurance from Continental Casualty Company. The policies provide that in order to qualify for benefits, claimants must demonstrate that the facility they live in meets the definition of a long-term care facility. The policy defines a long-term care facility as one that is licensed by the state. The individuals moved into managed care communities or assisted living facilities and applied for benefits. The company denied benefits on the grounds that the facilities were not licensed facilities.

The individuals filed a lawsuit against the company, arguing that the insurance company wrongly denied them benefits. They asked the court to certify a class of all people who currently own two specific types of long-term care insurance policies and a subclass of all people who owned long-term care insurance and were denied care at a managed care community or assisted living facility.

The United States District Court, District of Connecticut, grants class certification. The court rules that the class is easily ascertainable and including all current policyholders is not too broad. In addition, the court finds that the subclass is not too small to meet the numerosity requirement because the class will consist of at least 29 people. The court also rules that the plaintiffs have demonstrated commonality and typicality because they have shown that class members’ claims depend on a common contention that is capable of class-wide resolution.

For the full text of this decision, go to: