Margaret Gosselin learned to paint when she was 65 years old. Her work won awards, and one of her paintings even hung at the Massachusetts State House. 

These days, Margaret is no longer able to paint. Now 92, after fighting her way back from a stroke, she needs a little help with daily activities. So, she filed a claim with John Hancock, her long-term care insurance company. 

Within days, there was a knock on her door. Margaret tells the I-Team, “just right out of the blue. There was a woman standing there. She said, ‘I’m here to make an appointment.’ Make an appointment? she said, ‘yes you know to evaluate you.'”

The woman was a nurse and worked for a company hired by John Hancock to evaluate Margaret for her claim. Margaret says the woman asked if she wanted to do the evaluation now. Margaret agreed, telling the woman, “I said why not. She asked me all kinds of questions. The whole thing didn’t make any sense to me. I thought it was strange.” 

After that evaluation, John Hancock denied Margaret’s claim, even though over the years she paid the company more than $125,000 in premiums. 

“Industry has gone off the rails”

Sean Collins is Margaret’s attorney and handles long-term care Insurance cases. “It’s not OK at all,” Collins said. “Frankly it’s an example of how this industry has gone off the rails.”

Collins said “it’s totally inappropriate” for an insurance company to show up unannounced at a 92 year old woman’s house. 

“You know she has good days, she has bad days,” Collins said. They are showing up on people’s doorsteps unannounced when they know they have a son or a daughter or a loved one who is involved in the claim process and you know they are playing gotcha claim tactics with them.”

After the I-Team got involved and contacted John Hancock, the company sent a different nurse to evaluate Margaret, and her claim was approved. 

“The tactic is to try to catch someone on perhaps a good day and to prey on an older person’s desire to be independent,” Collins said. “It’s not just with John Hancock it’s with almost every major carrier I’ve ever dealt with.” 

Margaret is now getting the care she needs and is able to stay in her own home. “I’m happy. I couldn’t have done it without you,” Margaret told the I-Team. 

John Hancock says protocols were followed

In a statement, John Hancock said: 

“We adhere to established scheduling protocols which always include coordinating home visits with our customers in advance so that they can arrange for a family member to be with them if that is their preference. Those protocols were followed in this case, but we cannot share any more information out of respect for our customer’s privacy. Please know, we work closely with all our customers and their families to achieve positive resolutions. This case is no exception.” 

If you have long term care insurance and plan to file a claim, experts say insurers can ask for an evaluation, but it should be scheduled in advance and done in person. Also, plan to have a family member or friend with you at the meeting.