This case relates to an individual and his family, who claims that he is entitled to long term care benefits because of his inability to perform certain activities of daily living following a stroke. The insurance firm denied benefits to the man and his family after it was clear that he would make no further recovery from injuries suffered during his stroke, despite the fact that injuries of his nature were supposed to be covered under the plan.
Question(s) For Expert Witness
1. Please explain your specific experience working with long term care insurance, and especially the claims handling thereof.
Expert Witness Response E-124779
I have 20 years of experience in the Life, Disability and Long Term Care insurance industry, including 12 years with a Fortune 500 company. I held the position of claims manager at Northwestern Mutual from 2008-11. This was a newer operation and duties involved the build out of the system, hiring talent and claim training, product development, liaison to the field agents, development of best practices, SOP and claim guideline and oversight of claim administration. I then moved to another large insurance firm to take a position of the director of LTC claims where I perform many of the same duties as above. We have a third party administrator that makes claim decisions at the desk level and my job is to oversee the relationship and their decision making. My direct claim handling work involves the high risk decisions, formal complaint related claims, appeals, pending litigation and settlements, alternate plans of care and fraud investigations. I have been involved in the review of a number of bad faith claim cases involving either benefit eligibility or provider eligibility for LTC benefits.
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