Nursing Home Residents Face Uncertain Future With Long-Term Care Insurance Denials
As my dad used to always say, "it's no fun getting old," something that baby boomers are discovering as they begin to reach their golden years. More and more baby boomers are settling into nursing homes and are looking to make a claim on the long-term care insurance that many of them have been paying for over many years. But many people have been disappointed in this not-unreasonable expectation as the insurance companies have been denying claims on a regular basis.
Starting in the 1990s insurance companies began taking advantage of baby boomers by scooping up thousands of individual long-term care insurance policies. It seems that the expectation by the insurance companies was that the buyers would eventually give up paying the annual premiums and close out the files by taking the collected premium.
However, instead more and more claims are being made on an increasing basis. So more and more the long-term care insurers are unable to meet their legal obligations and are denying claims for illegal reasons in an attempt to avoid payment.
In essence the insurance companies were taking advantage of the elderly insureds by denying their claims for long-term care insurance. This left many people without any resources to pay for their nursing home care or other long-term care needs. This dishonesty on the part of insurance companies has resulted in a jump in lawsuits filed against insurance companies, many of which have been successful at thwarting the insurance company's attempts to avoid payment of the long-term care.
It had been argued that Zurich should be obligated to provide co-primary insurance coverage because it issued a trucker’s insurance policy to Rose Services. Zurich argued that coverage was barred because a reciprocal coverage provision in its policy meant that unless it provided coverage to Franklin, Zurich was not obligated to provide coverage to Key. 
Based on State Farm Mutual Automobile Insurance Co. v. Universal Underwriters Group, 182 Ill.2d 240 (1998), the First District Court reversed a ruling for 
Michael Hadrys, an Adjustable Forms employee, was injured while working on a construction project in Illinois called the River East Project. And as is typical in the construction industry, his insurance was an owner controlled insurance program (OCIP) meaning that it was covered through the owner of the job and not his direct employer. The OCIP was being covered by Reliance Insurance Co., who have since folded, and that's when things get complicated.
State Farm insured the vehicle that was damaged and filed suit against Pat Santucci for property damage only. Santucci was part owner of P.S. Coyote, a corporation that operated out of Santucci's Illinois property, where he also individually owned the horses, outbuildings and barn involved in the accident. Statewide covered P.S. Coyote and Santucci under a commercial general liability policy.
Plaintiff Galvan was taken to Northwestern Memorial Hospital in Chicago by ambulance after being injured in an automobile accident. Upon his discharge 15 days later he was presented with a hospital bill for $87,033. In his claim against Northwestern he alleged that their practice of billing uninsured patients twice the amount of insured patients was unfair and deceptive.
The statute seeks to protect construction parties from having to defend against stale claims. Since its inception the statute has been a balancing act between the rights of the injured party and the rights of the party responsible for the construction. Illinois courts generally have limited the statute to apply to claims of construction or improvement to real property. However, where some courts differ is on claims brought as to duties of maintenance and inspection.
