Insurance-Long-Term Care Policy-Guaranteed Issue-Existing Loss Exclusion

Plaintiff appealed the adverse summary judgment in her breach of insurance contract action. Plaintiff lost the use of her arms and legs in an accident 40 years prior and needed assistance with bathing, dressing and eating. However, she was able to work as a speech therapist with a state education agency. The agency offered its employees a guaranteed-issue long-term care policy that contained an exclusion for “existing loss.” Although plaintiff contacted defendant to learn more about the exclusion, she did not fully disclose the extent of her physical condition. When working became too difficult, she filed a claim with defendant, which denied coverage under the existing loss provision because her physical limitations existed on the day she enrolled.  

Where plaintiff’s physical limitations had arisen before the effective date of coverage, state law allowed defendant to enforce its existing loss provision to bar coverage for care that plaintiff was already receiving when she signed up for coverage.  

Judgment is affirmed. 

Child v. Unum Life Insurance Company of America (MLW No. 84745/Case No. 24-2347 – 9 pages) (U.S. Court of Appeals, 8th Circuit, Stras, J.) Appealed from U.S. District Court, Northern District of Iowa, Strand, J. (Steven M. Dunn, Miami, FL for appellant; Bruce Henry Stoltze Sr., Des Moines, IA on the brief) (Michael William Thrall, Des Moines, IA for appellee; Dana Waterman Hempy, Des Moines, IA; Dennis M. Lynch, Dallas, TX; and Timothy A. Daniels, Dallas, TX on the brief)