The Elder Law Forum by Professor Michael Myers If you or a member of your family suffer from alcoholism and are in the market for long-term care insurance, read the policy closely; specifically the section entitled "Limitations and Exclusions."
You may find language such as: "No benefits will be paid for any confinement, care, treatment, or services related directly, or indirectly, to alcoholism or drug addiction." This is the wording a USD
Senior Legal Helpline caller
(1-800-747-1895; mmyers@usd .edu) found in his policy.
"I'm 74, a recovering alcoholic and I may have a problem with my long-term care insurance policy," he said. "I've had the policy for 12 years and I've been paying premiums of $142 per month on my policy and $112 on my wife's."
He said he hadn't had a drink since Christmas of 1986. He suffers from severe leg neuropathy and uses a wheelchair most of the time. His physician believes the leg neuropathy may have been caused by years of heavy drinking.
"My question is this," he said: "If I need to go to an assisted living facility or nursing home in part because I can't walk, can the insurance company refuse to pay because my leg condition may be related to my alcoholism?"
"In your case, with that language, the answer is yes, at least theoretically," I advised. "But, practically, the answer is no."
A South Dakota Division of Insurance regulation states, "A long-term care insurance policy may exclude coverage for 'alcoholism or drug abuse.'" However, this language is generally interpreted to allow exclusion for care provided by facilities that primarily treat alcoholism and drug addiction, but not for care provided by a nursing home for a condition that may be "indirectly" related to alcoholism.
A tax-qualified policy written by the Allianz Life of Minneapolis states, "No benefits will be paid for any confinement, care, treatment or services for alcoholism or drug addiction."
Lincoln Benefit excludes care "provided in facilities operated primarily for the treatment of alcoholism or drug addiction."
Nevertheless, a word of caution: If alcoholism is in your background, read the limitation section and discuss it with the person who is asking you to buy the policy.