Appelate Decision

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The appellate decision involved a case that I brought on behalf of a nurse registry. They had been providing care to this individual and the insurance company refused to pay certain benefits. It was a policy that was I believe poorly written and basically what the policy required was for an individual to have what is called a skilled visit by a nurse or a therapist at least once a week in order to receive benefits for unskilled care like assistance with bathing and dressing and ambulating or walking, things like that. The individual in that case had not been getting a skilled visit once a week. Instead she was receiving the unskilled care, which is what she needed. She didn't need skilled nurses to come to her residence once a week. Basically, the policy required her to buy something or pay for something she did not need in order to receive care that she clearly needed and was clearly covered under the policy.

That just inherently didn't feel right so I asked the trial judge to enter an order against the insurance company, finding that provision of the policy requiring a skilled visit to be against public policy in the state of Florida. The trial judge did not like the policy, but declined it to find as a matter of law that the provision was against public policy. I appealed the decision; he ruled against us in the case. I appealed the decision to the appellate court and the appellate court to my surprise issued about a ten to twelve page decision that not only declared the policy was abhorrent, essentially requiring people to buy things they don't need in order to get things they do need, but it also opened up the door to what it really did. It established the public policy of the state of Florida. in that the state of Florida and the appellate court is directing the trial courts now to scrutinize long term care insurance policies even more carefully than other insurance policies are scrutinized by the courts because of what is at stake -- the long term care of individuals who had purchased insurance years ago and faithfully paid their premiums. It was a very significant decision.

The insurance company tried to appeal to the supreme court of Florida of the appellate court decision and the insurance industry, the long-term care insurance industry tried to join in the effort to overturn that decision. They tried to file what is called an amicus brief on behalf of the entire industry arguing that the decision had very far reaching consequences that would cost the industry a lot of money. The supreme court declined to take the case so that has become the law of the state of Florida. I was very grateful I lost the case in trial court because we ended up getting an important decision. So it was a great case.

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