Genworth Long-Term Care Insurance Denials

Although Genworth stopped selling new traditional LTC policies between 2016 and 2019, it continues to service its vast in-force blocks of policies, meaning millions of Americans are still reliant on its commitment. Genworth’s own materials emphasize the company manages the largest LTC block in the industry, servicing over one million policyholders and handling tens of thousands of claims

At Sandstone Law Group, we understand the immense distress and betrayal policyholders feel when, after years of diligent premium payments, Genworth denies their rightful benefits. We are committed to providing clear, empathetic guidance, standing firm against insurers like Genworth, who have a documented pattern of prioritizing profits over policyholder obligations.

Understanding Long-Term Care Insurance

The fundamental purpose of LTCI is to provide financial support for services when a chronic illness, a severe cognitive impairment, or a disabling condition renders it difficult or impossible for an individual to live independently.

Long-term care insurance policies typically stipulate that policyholders must satisfy one of two primary criteria to be certified as Chronically Ill or Disabled and thus eligible for benefits:

·         The individual must demonstrate a loss of the ability to perform, without Substantial Assistance, at least two Activities of Daily Living (ADLs).

·         The individual must possess a severe cognitive impairment, which necessitates Substantial Supervision to safeguard them from threats to their health or safety.

The six common ADLs are:

• Bathing: The act of washing oneself by sponge bath, or in either a tub or shower, including the critical task of safely getting into or out of the tub or shower.
• Dressing: The ability to put on and take off all items of clothing and any necessary braces, fasteners, or artificial limbs.
• Eating: The act of feeding oneself by getting food into the body from a receptacle (such as a plate, cup, or table) or through specialized means like a feeding tube or intravenously.
• Transferring: Sufficient mobility to move safely into or out of a bed, chair, or wheelchair, or to move from place to place, whether by walking, using a wheelchair, or by other assistive means.
• Toileting: The ability to get to and from the toilet, to get on and off the toilet, and to perform associated personal hygiene.
• Continence: The capacity to maintain control of bowel and bladder function, or, when unable to maintain control, the ability to perform associated personal hygiene (including the care of a catheter or colostomy bag).

If a person requires “substantial assistance” in two or more of these specified areas, they may qualify for benefits under their long-term care insurance policy. “Substantial assistance” can encompass either hands-on assistance or standby assistance, depending upon the precise wording of the policy.

If an individual is cognitively impaired and requires oversight that may include cueing through verbal prompting, gestures, or other demonstrations by another person, and such supervision is demonstrably necessary to protect them from threats to their health or safety, they may also qualify for benefits under an LTC insurance policy.

Genworth’s Legal History and Allegations of Bad Faith

Genworth Financial has long been a heavyweight in the long-term care insurance sector. With a national presence and a particularly large in-force policy population in states like California and Arizona, its influence on the LTC landscape is undeniable. For many consumers, Genworth was the primary, if not sole, option for securing LTC coverage for decades. Its business remains squarely focused on LTC insurance lines, making it a critical entity for current policyholders seeking to access their benefits.

Genworth's business model relies on the consistent payment of premiums by its nearly one million policyholders. The trust placed in such a large insurer is profound, as policyholders expect their claims to be handled fairly and promptly when the time comes to utilize their hard-earned benefits.

Genworth's reputation has been significantly impacted by a series of legal and regulatory challenges, particularly concerning its handling of long-term care policies. These issues often form the backdrop of individual claim denials, as they reveal a broader pattern of corporate behavior—one that underscores the importance of working with a skilled Long-Term Care Insurance Claim Denials Lawyer to challenge unfair practices.

1. Premium Increase Litigation and Settlements: Genworth has faced extensive litigation regarding its practice of implementing large, sudden premium increases after years of stable pricing. Policyholders, often retirees on fixed incomes, have reported "skyrocketing rate increase horror stories," including hikes of 143%.

• Skochin and Haney Lawsuits: These are examples of litigation alleging excessive rate increases.
• 2021 Settlement: A significant $137.5 million settlement was reached in 2021 over these allegations of excessive rate increases. This indicates a systemic issue acknowledged through legal resolution.

2. Reserve Misrepresentation and Financial Misconduct Allegations: Allegations have surfaced that Genworth intentionally underfunded its LTC reserves and misrepresented its financial position. Adequate reserves are crucial for an insurer to meet its future claims obligations.

• Leifer Class Action: This class-action lawsuit specifically alleged underfunded LTC reserves and that Genworth continued to implement premium hikes while hiding its LTC liabilities.
• High-Level Misconduct Claims: Accusations have been made against Genworth directors for manipulating reserve assumptions and backdating claims to understate reserve needs and mislead investors.
• 2013-2016 Regulatory Scrutiny: Genworth admitted to under-reserving during this period, which led to shareholder lawsuits and a $219 million settlement over misstatements.
• 2022 Class Settlement: A settlement was reached across multiple policy forms for non-disclosure of reserve strategies in various states, including California, New York, and Virginia.

This extensive history of alleged financial mismanagement and aggressive premium increases suggests a systemic approach to mitigating future payouts, which can translate directly into a more challenging environment for policyholders attempting to claim benefits.

Tactics Genworth Uses to Deny Disability Claims

Genworth, like other major insurers, carefully manages long-term care claim approvals and payouts as part of its overall cost-control efforts.

• They challenge your care providers. Genworth routinely challenges whether your chosen caregivers meet their narrow interpretation of policy requirements. We've seen them reject family members providing essential care, question the credentials of licensed home health aides, and demand you switch to more expensive facilities they prefer. 
• They manipulate the elimination period. Your policy requires you to pay out-of-pocket for a certain number of days before benefits kick in. Genworth loves to argue that some of those days "don't count"—maybe because your daughter helped you shower instead of a licensed aide, or because you had a good day and didn't need as much help. Suddenly, what should have been a 90-day elimination period stretches to 150 days or more.
• They bury you in paperwork requests. We see this constantly: Genworth asks for the same documents multiple times, claims they never received forms that were clearly submitted, and demands increasingly obscure medical records. The goal is to exhaust you into giving up. Many elderly policyholders simply can't keep up with the relentless requests for information.
• Their "independent" doctors aren't independent. When Genworth sends you to an Independent Medical Exam, that doctor often works regularly with insurance companies and rarely finds in favor of claimants. These fifteen-minute appointments can override years of careful documentation from your treating physicians who actually know your condition.
• They cherry-pick your medical records. Your doctor says you need substantial assistance with daily activities, but Genworth will find that one note where you had a better day and use it to argue you are not really disabled. They ignore the full picture and focus on anything that supports denial.
• They offer lowball settlements when you're desperate. When mounting care costs have drained your savings, Genworth may offer to settle your claim for a fraction of what you're owed. These offers come when families are most vulnerable and least able to fight.

Common Reasons for Genworth Claim Denials

Building on the tactics discussed, denials from Genworth often manifest in these specific categories:

• Failure to Meet Eligibility Requirements: Genworth concludes you do not meet the minimum number of ADL triggers or the severity of cognitive impairment required by your policy. They often dispute the functional necessity of your care.
• Documentation and Paperwork Issues: Denials frequently occur due to allegedly "incomplete or missing paperwork," or because daily care logs are deemed insufficient or inconsistent.
• Provider Qualification Problems: Your claim may be denied because your care provider or facility does not meet Genworth's strict interpretation of policy requirements for licensing, certification, or "approved" status.
• Elimination Period Not Satisfied: Denials can occur if Genworth determines that the elimination period was not fully satisfied according to their specific counting rules (e.g., due to breaks in care, using unqualified providers, or differing interpretations of "days of service").
• Policy Exclusions or Limitations: Sometimes Genworth digs deep into policy exclusions, claiming your need for care falls under some obscure limitation you never knew existed. These denials often involve territorial restrictions or narrow definitions of covered care.

Why Sandstone Law Group is Your Advocate Against Genworth

Fighting a dominant insurer with a history like Genworth's can feel like an overwhelming task. They are a massive entity with significant resources, often employing strategies designed to deter insureds and protect their financial interests. You do not have to navigate this complex process alone. While an appeals process may be offered, whether to pursue an appeal or immediate legal action is a case-specific consideration that requires legal advice.

Sandstone Law Group focuses on challenging long-term care denials, including those from Genworth. We are committed to:

• Aggressive Advocacy: We stand firm and aggressive against insurers like Genworth who fail to honor their commitments. Our goal is to ensure you receive the benefits you are owed.
• Building a Robust Case: We meticulously review your policy, gather compelling medical records and financial documentation, and build a strong argument that directly counters Genworth's denial reasons. 
• Strategic Legal Counsel: We provide clear guidance on the best path forward, whether that involves preparing a detailed appeal or pursuing litigation when necessary. We ensure your rights are protected and that all procedural requirements are met.
• Holding Insurers Accountable: We represent policyholders who purchased LTC plans years ago and are now finding that companies are "not honoring them". We are dedicated to fighting for justice and ensuring accountability for delayed or denied benefits, particularly given Genworth's extensive legal and regulatory history.

If you are facing a Genworth claim denial, or are struggling with delays and endless paperwork, do not concede your rightful benefits. The time to act is now.

Contact Sandstone Law Group Today

If your Genworth long-term care claim has been wrongfully denied or if you are experiencing frustrating delays and confusing communications, it is time to seek legal guidance.

At Sandstone Law Group, we are not intimidated by insurers like Genworth.. We take on cases that others may shy away from, prepared to fight relentlessly to hold these companies accountable when they fail to honor the long-term care plans you purchased.

Contact us today at 602-615-0050 to schedule a consultation. Let us uncover the truth, enforce your rights, and make sure your insurer delivers the protection they promised.