Court Calls Assisted Living Facility "Long Term Care"

In a case regarding coverage under a long term care insurance policy, a U.S. District Court in Ohio has decided that an assisted living facility qualifies as a "long term care" facility, even though it did not have a nurse on site 24/7.

In this case, Hoekenga vs. Continental Casualty Company (U.S. Dist. Ct., S.D. Ohio, No. 1:06-cv-458, April 18, 2007), Mrs. Hoekenga took out a long term care insurance policy that provided coverage as long at the facility provided 24-hour-a-day nursing services.  The assisted living facility in this case provided nursing services 24/7 with a nurse supervising the care.  But the nurse was not on-site 24/7 and the insurance company attempted to use this as a reason to deny coverage.

The Court agreed with Mrs. Hoekenga and decided that the term "supervision" does not require that a nurse be on site at the facility on a 24-hour-a-day basis.

Comments

[Jason Hill]

This is an interesting case to hear about. I can see the word 'supervision' being able to be interpreted either way. I guess what ultimately matters is that costs don't change and that patients receive prompt help when they need it.

[Assisted Living Minnesota]

Thanks for information!