Upland Man Suing Health Insurance Company For Failing To Pay Medical Claims

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UPLAND – An 87-year-old Upland man is taking on his health insurance company on behalf of seniors across the state.

William Hall, through his attorneys, filed a lawsuit Wednesday in West Valley Superior Court in Rancho Cucamonga against Senior Health Insurance Co. of Pennsylvania, for allegedly denying claims on his long-term health care policy.

"I've been disappointed because they have failed to perform," Hall said.

Attorneys for Consumer Watchdog in Santa Monica and the firm of Shernoff Bidart Echeverria Bentley LLP in Claremont filed the suit on behalf of Hall as well as potentially 10,000 other policyholders facing similar situations with the insurance company.

"In a sense it violates everything America is all about," said Harvey Rosenfield, founder of Consumer Watchdog and an attorney for Hall.

"It's a betrayal of trust. It's preying on the most vulnerable people in our society. People, by the time they're that ill, they're not in any position to fight with an army of insurance bureaucrats."

Attempts to reach Senior Health Insurance Co. of Pennsylvania were unsuccessful.

According to the lawsuit, the insurance company told policyholders who filed claims under their long-term-care policies that caregivers who come to their homes must be licensed, when that is not required.

The lawsuit also alleges the company required policyholders to produce extensive documentation not required by the policy as well as undergo unnecessary medical examinations by personnel selected by the company.

Hall, a former Army colonel who earned a Purple Heart in the Korean War and the former chief of medicine at Kaiser in Fontana, purchased his policy from Transport Life Insurance company in 1994.

Policies through Transport, American Travelers Life, United General Life and Continental Life Insurance companies were transferred to Conseco Senior Health Insurance Co. between 1998 and 2000, which was renamed Senior Health Insurance Co. of Pennsylvania in 2008.

In 2010, Hall submitted a claim for benefits covering the services of a personal caregiver to assist with his daily living at home.

"I submitted a claim for home-care services which is what their policy should cover and their response has been a series of requirements for more and more detailed type of documentation," Hall said.

"They have just been outrageous in their demands for detailed and frequent documentation of my home-care services."

The company delayed his claims for months and then paid 20 percent of what it owed, said William Shernoff, an attorney representing Hall.

Hall spent money from his savings to cover the medical costs not reimbursed by the insurance company.

"There is no other way," Hall said.

The lawsuit is seeking payment to Hall for benefits included in his policy as well as related damages, which could include payment to thousands of other seniors in the state.

"That's the goal of the lawsuit," Shernoff said. "To not only compensate these people for what they deserve, but to stop these practices, bad practices against the elderly in the future."

Reach Sandra via email, call her at 909-483-8555, or find her on Twitter @UplandNow .

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