KPRC 2 Investigates: Woman denied coverage after paying premiums for 20+ years

You think you are doing the right thing planning for your future. But one Deer Park family is learning that long-term care insurance isn’t the safety net they thought it was. KPRC 2 Investigates is helping one viewer looking for answers to why his mom can’t get the help she needs. Plus, we have everything you need to know about researching insurance companies and what to know before buying a new policy.

Denied long-term care insurance

Viewer Jeff Yates contacted us for help trying to figure out *why* his mother was denied home health care on a long-term care policy she’s been paying for more than 20 years. Mary Yates has always been independent but at 83 and recovering from a broken pelvis, she now needs help doing everyday things.

A former high school principal, Mary has always been a planner, so she thought she prepared for this phase of her life decades ago.

“When I retired, I thought, well, the next step is my, my care when I’m older,” explains Mary. “And so I thought the thing to do is take out long-term care.”

She’s paid her monthly premiums without fail. Right now she’s paying $540 a month for Jackson National Life Insurance long-term care policy. But Mary and her son Jeff were shocked to learn her long-term care insurance says she doesn’t qualify for home health care.

According to the policy, Mary says she does.

“It’s to the activities of daily living that you cannot, if you cannot perform those, then you qualify for care,” said Mary.

Why was Mary’s long-term insurance claim denied?

A Jackson spokesperson told us the claim was denied because - quote “there is no evidence that the claimant’s request for benefits satisfied the terms and provisions of coverage as described in the policy.”

“Apparently, they don’t believe that she’s, she needs this in-home care that she’s paid for for over the last 21 years,” said Jeff.

Mary first purchased the policy from USAA but it has changed hands over the years.

And people complaining to the Better Business Bureau about Jackson also say they didn’t choose the company.

“I have seen many people in their complaints reviews say that you know, it used to be this and then it changed names, or my insurance company sold all their contracts to this to Jackson this company,” explains Ashley Gibbard, Better Business Bureau.

Jackson has one out of five stars with the BBB.

“I’m so disappointed in this company,” said Mary. “let’s not give our senior citizens a terrible time when they are at their lowest. Let’s let you hold up the end of your deal that we made.”

A representative with Jackson National says Mary can appeal the decision. The Yates Family says they’re going to get a letter from Mary’s doctor confirming she’s chronically ill before appealing.

Resources related to long-term care insurance

Texas Department of Insurance

NICB | National Insurance Crime Bureau

What to look for when shopping for Long Term Care Insurance

Texas Department of Insurance

Full statement from Jackson National regarding Mary Yates claim

“The claim was denied due to the fact that there is no evidence that the claimant’s request for benefits satisfied the terms and provisions of coverage as described in the policy. The claimant has been notified that if there is any additional documentation or medical records not previously submitted that would substantiate the claim, Jackson will be pleased to reconsider its denial.”

Jackson Spokesperson


About the Authors:

Passionate consumer advocate, mom of 3, addicted to coffee, hairspray and pastries.