Judge rules for insurer in dispute over nursing home coverage

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An Ohio man is not entitled to insurance coverage at an assisted living facility because his insurance policy only covers services at a state-licensed nursing facility, a federal court has ruled.

Howard A. Michel was hospitalized for four days due to a head injury. He then was admitted to an assisted living facility for follow-up care. American Family Life Insurance Co. (Aflac) initially covered expenses upon learning that its call center mistakenly told Michel's sister that services would be covered. But Aflac denied further claims when Michel remained at the facility. Michel then sued Aflac.

Judge David A. Katz of the U.S. District Court for the Northern District of Ohio disagreed with Michel's claim. The policy clearly only covers skilled or intermediate nursing care in a facility that is "licensed as such by the state," he said.