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Home : About Us : Success Stories

Success Stories

Helping An Old Soldier Fight On

It has been decades since Henry DeWitt went to war. and he still has battles to fight.

At least he’s not alone.

A World War II veteran, DeWitt was diagnosed with post-traumatic stress disorder resulting from his military service.

In recent years he also has suffered from Alzheimer’s disease, vascular dementia and related depression, anger, and anxiety.

Dementia impaired his short-term memory but, in a cruel twist of fate, it also allowed his repressed memories of war to vividly resurface, making him angrier and even more depressed.

As his condition worsened, DeWitt was admitted into an inpatient mental-health facility for more than a month, and then discharged to a community-based residential facility, where he participates in adult day care five days a week.

He submitted a claim for this service under his insurance policy, which covers skilled nursing facility care, assisted living facilities, home health care and adult day care. It was a policy DeWitt had maintained for 10 years, paying $310 a month in premiums.

But the insurer decided that DeWitt’s care, because it was not full-time, didn’t qualify for reimbursement under the policy. His claim was denied.

A lawyer with Legal Action of Wisconsin’s SeniorLAW program investigated DeWitt’s claim, and discovered that the rules governing payments under his insurance policy did not meet Wisconsin state regulations. The attorney submitted a grievance request to the insurance company, citing the specific regulations that applied, and submitted supporting documentation from DeWitt’s health-care providers.

As a result, DeWitt’s insurance company overturned the denial, granting him payment on
$42,000 in long-term-care costs.

(client’s name has been changed to protect privacy)