Michaels, Schulwolf & Salerno has extensive knowledge and experience in the long term care insurance area, in both the regulatory and litigation arenas. Firm attorneys are familiar with the multiplicity of benefits triggers that have been employed over time under non-tax-qualified policies, as well as with the typical, Internal Revenue Code-based triggers found in tax-qualified policies. The firm has handled regulatory inquiries, coverage analyses and litigation concerning issues pertaining to:
- Eligibility for benefits (including eligibility based on the need for substantial assistance with Activities of Daily Living, the need for Substantial Supervision due to a Severe Cognitive Impairment, and medical necessity-based triggers);
- Home health care provider and facility provider eligibility and licensure issues;
- Whether costs fall within the scope of Qualified Long Term Care;
- Statutory and regulatory compliance issues; and
- The scope of coverage under various policy benefits (including nursing home, assisted living facility, home health care and independent caregiver benefits).
With respect to litigation, Michaels, Schulwolf & Salerno has handled long term care insurance coverage suits, including extra-contractual liability claims, in a multiplicity of jurisdictions. The firm is sensitive to cost issues pertaining to litigating these types of claims.
Accordingly, our litigation approach focuses on controlling litigation costs, working with the client to assess the potential for and pursuing settlement in the initial stages of litigation, and identifying and pursuing early dispositive motion practice opportunities.
Regarding statutory and regulatory compliance, Michaels, Schulwolf & Salerno has gathered an extensive knowledge-base concerning all state variations on the provisions of the National Association of Insurance Commissioner’s Long-Term Care Insurance Model Act and Long-Term Care Insurance Model Regulation, as well as unique state statutes and regulations. Michaels, Schulwolf & Salerno attorneys have analyzed and continuously monitor statutory and regulatory developments in the long term care insurance context nationwide. The firm has current analyses, and monitors and tracks state statutory and regulatory developments, in such areas as:
- The history of long term care statutes and regulations;
- State choice of law decisions made in the long term care insurance and analogous contexts;
- Minimum benefits requirements;
- Standards for benefits triggers; and
- Home health provider regulation and licensure.
The firm has substantial experience in representing long term care insurers in connection with state insurance department complaints and inquiries, and in successfully guiding carriers through those processes.
Michaels, Schulwolf & Salerno also is well-positioned to advise its clients concerning how to minimize the risk of lawsuits and of statutory and regulatory non-compliance, due to the firm’s knowledge in and experience with how carriers and third-party providers handle long term care insurance claims, its statutory and regulatory knowledge base, and its extensive experience with extra-contractual liability claims both generally and in the long term care insurance context.
If you wish to learn more about the firm's long term insurance practice, please contact Jan Michaels.