Long-Term Care Insurance Policy Does Not Cover Resident of Residential Living Center

A U.S. court of appeals rules that a long-term care insurance policy does not cover the resident of a residential living center because the center does not meet the definition of an assisted living center under South Dakota law. Van Dusseldorp v. Continental Casualty Company (U.S. Ct. App., 8th Cir., No. 18-3257, March 10, 2020)

Leona Van Dusseldorp purchased a long-term care insurance policy. The policy provided benefits if Ms. Van Dusseldorp required long-term care in a “long-term care facility” or “assisted living center.” Ms. Van Dusseldorp was diagnosed with early Alzheimer’s disease and moved into a registered residential living center. She filed a claim for benefits. The insurance company denied the claim because the residential living center was not a long-term care facility or assisted living center.

Ms. Van Dusseldorp sued the insurance company, arguing that the residential living center falls within the policy’s definition of an assisted living center. The district court found that the residential living center is not an assisted living center under South Dakota state law, so it is not a covered provider under the policy. Ms. Van Dusseldorp appealed, arguing that the policy defines an assisted living center as providing “personal care and services which meet some need beyond basic provision of food, shelter, and laundry” and those services are provided by her residential living center.

The U.S. Court of Appeals for the Eighth Circuit affirms, holding that the residential living center is not a covered provider. According to the court, the residential care facility could “legally provide the services called for in [Ms.] Van Dusseldorp’s specific Care Plan, but not all the services that South Dakota authorizes an [assisted living center] to provide.” The court notes that the residential care center could not administer medicine to Ms. Van Dusseldorp, while an assisted living center could.

For the full text of this decision, go to: https://ecf.ca8.uscourts.gov/opndir/20/03/183257P.pdf

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