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It seems like Suze Orman doesn't have anything to do with this issue. This seems more like an issue of the definition of immediate family and also \"living with you\", and probably best decided by a court.
The reason behind the \"immediate family member\" clause is to prevent people from having their kids take care of them and then getting reimbursed for their time, as it is commonly held that your kids would take care of you for free. In short, its to prevent abuse of the system. What I don't understand here is this- after the first claim was denied, why didn't she just hire a nurse who wasn't her daughter? This would have provided her with the care she needed and would have been reimbursable. Plus, her daughter could still care for her.
I can see the gray area though, as I would imagine that once the mother is debilitated by the chemo, the daughter probably started staying over more and more often, at which point she would become an immediate family member living with her.
@Joe Reilly: One of the reasons you get insurance is that your family doesn't have to provide you with free medical care. If a nurse was medically justified, what is the abuse?
If I needed a nurse and my daughter was a nurse, I'd prefer to have her care for me. And if I paid for medical insurance that covers nursing, I don't see why my daughter should be donating her time.
If there is abuse, that's one thing. But there can always be abuse with medical insurance and there's nothing specific about this situation that makes it appear to be abuse.
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That is exactly correct.
I deal with these types of contracts on a daily basis. The usual language (for the major carriers, Genworth, John Hancock and Metlife) is \"Care cannot be provided by a family member unless they are A. A Licensed Care Provider, and B.They are paid through an agency that provides care\"
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@Joe Reilly: CNA Financial says their fine print stipulates that NO family member qualifies, whether living with you or not. They rejected the claim based on that. As far as I can tell from the Forbes article, her daughters never moved in with her, at least not officially. But simply by being her daughters, they were ineligible, which they claim is not what Garat was led to believe.
@Chris Walters: They must be looking for a quick settlement. Since it will be impossible to prove what a dead person knew and didn't know. And it's pretty reckless for them to cite a brochure and to have never looked at the actual details. It sounds like they didn't realize they had to hire someone unrelated and despite their own failure to follow the rules, they now want the same amount of money they could have gotten had they hired a nurse. This clause is specifically in there to protect the company from this very thing. I don't see how they can win.
@Corporate_guy: Agreed, it doesn't look good. Assuming no one involved deliberately acted maliciously, I imagine the agent who sold Garat the policy also overlooked the fine print. I don't know who printed the brochure, but I don't see how that can be treated as equivalent to the fine print of the actual agreement.
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Is this the same insurance company that won't cover hurricane damage because it was water and not wind that destroyed your house?
@Blueskylaw: I don't know of a single insurance company that doesn't do that, since the NFIP is just about the only place to go for flood insurance.
If they can \"prove\" (that is, \"say\") that water caused more damage than wind, they will refuse to pay.
@Blueskylaw: All insurance companies know that if it was the wind which damaged the home, then the home owner should have purchased separate tornado coverage...