Long term care issues addressed at hearing

Regulators and insurance executives yesterday addressed consumer protections for long term care insurance before the House Committee on Energy and Commerce. Consumer protections and state partnership arrangements with insurance companies were among the topics at the hearing, which took place before the subcommittee on oversight and investigations. An issue hampering the LTC industry is the matter of denied claims, noted Bonnie Burns, a training and policy specialist at California Health Advocates in Scott Valley, Calif. State regulators currently handle market conduct examinations, but such investigations may not address claim complaints. “[T]hese examinations may not focus on individual contract issues resulting in a disputed claim, thus allowing companies to continue making an unreasonable interpretation or application of contract terms,” said Ms. Burns in her testimony. On the regulators’ side, top priorities include ensuring solvency of LTC carriers, mandating proper and suitable sales and keeping consumer protections in place to ensure receipt of benefits, noted Sean Dilweg, insurance commissioner of Wisconsin. Other steps discussed included the National Association of Insurance Commissioners’ long-term-care insurance model regulation,” which requires insurers to develop suitability standards that weigh applicants’ ability to pay and their goals for long-term care. The NAIC is based in Kansas City, Mo. Insurance executives were also present to discuss their companies’ approach to satisfying claims and ensuring proper sales. Among them was John Wells, senior vice president of long-term care at Conseco Inc. of Carmel, Ind. The carrier was recently subject of a multistate investigation by insurance commissioners for claims complaints. However, it has since changed procedures, Mr. Wells said. “I sincerely hope that the committee doesn’t allow a small percentage of times we didn’t make the appropriate payment to drown out the huge percentage of cases in which we make good on what we promise,” he said.