Why was the insurance claim denied?
The original denial lacked clarity, so Gilbert assumed there must have been some kind of oversight. After the initial denial, Gilbert hired an attorney and spent $5,000 to challenge the company’s decision.
Despite his efforts, the claim was denied again — this time citing the policy’s stipulation that coverage applies only if the memory care facility has a full-time, 24/7 on-site nurse. While the facility where his father resides does have a nurse available around the clock, the nurse works at multiple locations and is not at his father’s facility exclusively. This technicality renders the policy inapplicable.
“I’ve tracked since 2001,” Gilbert told 9News. “He’s paid well over $20,000, $25,000 for this policy.”
US Life, the company that sold the policy, did not respond to 9News' request for comment. But Gilbert and Seger say it’s likely many others have policies with similar verbiage if they were purchased around the same timeframe.
Changes in the healthcare landscape may be partially to blame. While many facilities may have had a nurse on site 24/7 in 2001 when Gilbert's dad purchased the policy, many assisted living facilities are now chronically understaffed.
Recent changes to nursing home regulations may help, but the new rules will only take effect in 2026. By this time, an RN must be on duty at all times, even on weekends and overnight, in case of a patient crisis.
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Explore better ratesA son's warning for others: Check your old insurance policies
Gilbert plans to cancel his dad's policy after the first of the year to avoid paying additional premiums. While he doubts he'll ever receive any compensation from the policy, he hopes sharing this story will help others save money and prevent frustration.
Gilbert believes his father would be angry if he knew how the situation turned out, as he purchased the policy to protect him financially. Instead, Gilbert is now left footing the bill despite his dad paying years of premiums.
Gilbert suggests everyone check the requirements on old insurance policies. Ensure they offer the coverage you expect and that the underwriting is relevant today. If the policies are no longer appropriate or won't provide the coverage you expect, consider revisiting your insurance options.
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