Kreisman Law Offices Professional Corporation
Marie Gardiner purchased a long-term care policy from insurance company giant CNA in 1993. The idea was to have security in knowing that in the event of her need for a nursing home or an assisted living facility to take care of her, she would have this policy in place. Gardiner unfortunately broke her hip in 2008 and moved into The Village at Buckland Court (Village). She then filed a claim with CNA, and it was approved. When her health improved, CNA terminated the coverage for the claim in 2011 advising Gardiner that if her “care needs change or increase in the future,” the company would review her policy.
In 2012, Gardiner fell down a flight of stairs and fractured her sacrum. She reapplied for benefits at CNA under the long-term healthcare policy. CNA denied her claim, noting that the Village was “not a qualified provider.”
In the lawsuit Gardiner filed against CNA, she stated that a company representative denied her claim because a nurse was not on the premises at all times and because the Village was a “managed residential community,” not a licensed assisted living services agency.