The American Association for Justice (AAJ) has put “insurance denials” alongside “chemical restraints,” “neglect” and “bed rail deaths” in a report on elderly Americans and the civil justice system.

The AAJ, Washington, a group formerly known as the Association of Trial Lawyers of America (ATLA), developed the report to show how AAJ members believe their colleagues are standing up for elderly Americans.

“The business of nursing homes has never been more corporate,” the AAJ says in the report. “Loopholes in legislation have been exploited, and regulations and inspections have proven woefully ineffective…. The same is true of insurance companies that mislead and defraud vulnerable seniors. Insurance industry regulators protest that they can do nothing. Even when they do raise their hands, they more often than not strike deals to keep fines to a minimum and settlements secret.”

Because regulatory and legislative bodies are unable to cope with all of the neglect and abuse, “the civil justice system has stepped into the breach,” the AAJ says. “Attorneys who represent our nation’s seniors, and their families, play a critical role in uncovering abuse and neglect, and are the most effective force to compel corporate nursing homes to fix their conduct.”

The AAJ highlights the case of a South Dakota man who paid for long term care (LTC) insurance and then was told after he spent 3 years in a nursing home that he

could no longer collect benefits because his stay in the home was not medically necessary.

“Unbeknownst to Rudy, he was just one of thousands of seniors who had their benefits cut by insurance companies that put profits before people,” the AAJ says. “Those companies had signed up a flood of seniors for long-term care insurance in the 1990s, but did not like the idea of paying the benefits they had promised. Many of these insurance companies had miscalculated the mortality rates.”

Attorneys found and stopped insurance company efforts to hold down costs by terminating valid claims, the AAJ says.

The AAJ also includes accounts of efforts to persuade consumers to buy LTC insurance policies with misleading initial prices and to replace existing life insurance policies with new policies without a valid reason.

Attorneys helped the consumers affected by those efforts obtain recoveries, the AAJ says.

- Allison Bell