Florida life insurance carriers may wrongfully fail to add contracted-for annual benefit increases when calculating lifetime maximum benefits.

Investigation and pending class action lawsuit against Pioneer Life Insurance Company ("Pioneer Life") and Washington National Insurance Corporation ("Washington National").

Pioneer Life and Washington National sold Limited Benefit Home Health Care Coverage Certificate of Insurance ("Policy") to Florida consumers. Pioneer Life or Washington National has rejected all or a portion of a claim on the Policy because the consumer exceeded the Lifetime Maximum Benefit Amount.

The Policy, however, expressly provides for an 8% annual increase for all benefits. It appears that certain consumers in Florida were not given the 8% increase in annual benefits, as Washington National has allegedly denied claims of Florida consumers because they have reached the original lifetime maximum benefit. In an October 4, 2007 decision from the United States Court of Appeals for the Eleventh Circuit, the court reversed an order of the United States District Court for the Southern District of Florida and held that "it would be reasonable for an ordinary person to conclude that all benefits increase by 8% each year" and that under Florida law, where reasonable interpretations in an insurance policy provide for ambiguity, the terms are to be construed liberally in favor of the insured and strictly against the insurer.

If you purchased a Policy in the State of Florida from Pioneer Life or Washington National and your benefits stopped because they exceeded the lifetime benefit, and would like further information or would like to discuss your situation with us, please contact us.