UPDATE 2: Vicki was the buyers agent for Ms. Lile in purchasing a policy from Penn Insurance based in Pennsylvania in 1996. When Ms Lile attempted to gain her benefits she was unable to because the insurance company had filed for bankruptcy. Now that the funds are accounted for, Ms. Lile should be able to receive funds from the state distribution. While Vicki has attempted to assist with Ms. Lile receiving monies due. She has no fault in the case and is not a proper party for action.
UPDATE: Vicki has posted on social media that she is not an insurance carrier. Therefore, she has no ability to deny a policy. As it turns out, Vicki doesn’t write insurance policies. Her company is a financial services agency that provides assistance with purchasing insurance, planning for retirement, estate planning, asset protection, etc. So it sounds like the plaintiff is suing the wrong party. Or she is trying to blame Vicki for steering her to a crappy insurance company/policy. Either way, this case is going nowhere.
RHOC’S Vicki Gunvalson and her company Coto Insurance & Financial Services have been accused of of fraud, breach of fiduciary duty, negligence, intentional infliction of emotional distress and breach of contract in a newly filed lawsuit.
And 82-year-old woman, Joan Lile, has filed a civil complaint against the OG of the OC and her insurance company for breach of contract.
What Is Long-term Healthcare Insurance?
According to court documents obtained by The Blast, back in 1996 one year after Vicki Gunvalson began he insurance company, Lile purchased a policy for long-term care insurance. Long-term care insurance is purchased to assist with the ridiculous costs the elderly face during the last portion of their lives. It is mean to defray the costs of assisted living and other medical expenses incurred late in life. These expenses often wipe out all of the assets of the elderly. It’s yet another shameless travesty of the US Healthcare system.
Joan Lile and her husband Robert Lile were concerned about financial planning for Joan’s healthcare because Robert was significantly older than Joan. In the 1990s the first long-term healthcare policies were offered by insurance companies. Vicki Gunvalson’s policy with the Liles occurred during this time.
The Lile’s Purchased Long-term Healthcare Insurance When It Was First Offered
In 1996, Lile claims her and her husband Robert purchased a policy of long-term care insurance from Vicki Gunvalson. They said they were looking for a policy that if one spouse passed away, all future medical premiums for the surviving spouse would be covered on the policy. They chose a policy that provided a Survivors Waiver of Premium, (SWOP) clause that would ensure the surviving spouse had medical and assisted living benefits for the surviving spouse free of additional premiums.
The crux of this suit depends on whether or not the policy that Lile purchased actually had a SWOP clause.
Then Long-Term Healthcare Premiums Skyrocketed
Lile’s lawsuit claims that Vicki Gunvalson, and the insurance company preyed on the confidence and trust of the Liles but assuring them that they were covered by a SWOP clause. Lile claims she was assured that this clause was in the contract and would receive the benefits of SWOP upon the passing of either spouse. In 2016 and again a few years later premiums for these policies skyrocketed. But the Lile’s continued to pay the new extremely high premiums.
I Wonder What Happened To the Fraud Suit Over The Vodka Deal With Vicki And Brooks?
When Robert Lile passed away in 2017, Joan tried to exercise the benefits of the SWOP clause which would allow her to stop paying the premiums on the insurance while remaining eligible for benefits.
Vicki’s insurance company has continued to bill her for the premiums she doesn’t feel she owes due to the SWOP clause. So Lile is suing for damages.
When Lile Tried to Exercise Her SWOP Benefits She was Denied
This is a fairly basic case of contract law. A judge will read the contract signed by the Liles. If there is a SWOP clause in the contract, then Joan Lile wins her case. She isn’t required to pay the premiums. And, she will be refunded any premiums that she paid since her husband’s death. In addition, her attorneys can claim emotional distress. She’s 82. She was devastated over the benefit she was promised in the contract.
On the other hand, if Joan and Lile’s insurance policy does not have a SWOP clause. Joan will continue to owe the premiums and will receive only the benefits stated in the policy. The end.
What Does The Contract Say?
Based on the civil suit, her attorneys seem to be saying that Vicki Gunvalson and/or her sales rep told her the premium contained a SWOP clause when it did not. So. she paid premiums for years on a premium that she thought had a SWOP clause.
There are a few problems with this defense. First of all, people don’t call their insurance broker several times over 20 years to confirm coverage They buy the policy with the coverage they desire and stick it in a safe deposit box somewhere until such time as a claim can be made.
This Concludes Your Lesson In Contract Law
There is no way to prove what Vicki Gunvalson or any representative of Coto told Joan in 1996. It’s possible she said there was a SWOP clause when there wasn’t. Maybe she said a monkey shitting emeralds will show up at her door after her spouse passed. Perhaps she carefully explained that there was no SWOP clause in this policy and recommended another. All that matters in 2019 is what is in the contracted that was signed by all parties.
So, in my opinion, this is a run of the mill case. And the reason businesses have a legal department. But, I figured y’all would be asking, so now you know. I’ll update you if we hear the outcome. It seems to me like a story for a slow news weekend.
I admit I am doing the same thing. But I also included a retrospective of the many faces of Vicki Gunvalson and that should count for something, dammit.
I don’t really care about the lawsuit, suits with these Bravolebrities happen all the time. I am just hear to chime in on the ridiculous manner with which we deal with the elderly. I have recently had the displeasure of dealing with nursing homes, medicaid, assisted living, home sales, etc. The elder care and insurance industries are fleecing middle and lower class American’s of their entire life’s savings. It is truly disgusting.
Healthcare and Health Insurance is the primary reason I am working my plan to move to Costa Rica. Step one: Get a beach body. LOL. I can’t take Banjo so I’m here as long as he is.
Step one could be to go ahead & move to Costa Rica. You can get the beach body there. The plastic surgery (& dentistry) there is terrific & very reasonable. LMK if you need referrals.
Need to stack a bit more cash and I am not moving while Banjo is alive. He would not survive a flight and is getting old. If I can get a dog sitter, which is highly unlikely, I might fly down and start the paperwork for legal residency earlier.
Yeah, I am going to have to come up with some sort of plan for myself. Living the final years of my life in a beautiful, foreign country doesn’t sound too bad. But I am hoping things change before I need to be worried about it.
Also, when you die in Costa Rica they just come get the body and plant it somewhere within 24 hours. No funeral expenses and your family doesn’t even have time to come for a funeral. Easy peasy.
I worked for years on insurance claims that go to litigation. Surprised this lady got a lawyer who would take her case if the clause is not in the written contract. Most would advise her (correctly) that it’s hopeless, written trumps verbal etc etc and it would never get this far, so maybe they do have something? A different version of the contract to Cota or some copies of correspondence perhaps.
When I was denying claims I always told the client to go to lawyer who gives the first consultation for free just so they hear it from someone else that the product disclosure statement may as well be chiseled into a tablet, but don’t spend any further cash chasing an impossible outcome.
Sorry for the long winded post. I am an insurance nerd, but Tamara you were spot on with all your commentary. Before anyone thinks I am a huge asshole, I fought tooth and nail to find any little loophole to pay claims, that was how my company operated, but that’s a rare thing. Denying little old lady’s claims is the worst.
Sorry that was not a reply – it was meant to be a new comment, but Costa Rica sounds good to me. I am all for not soaking the earth in embalming carcinogens.
I have donated my body to a local medical school. When the med students are finished, the cremation is free, & if desired, the cremains are returned to family. If not, they are buried free, along with those of other donors with a nice little ceremony. No coupons necessary for this deal, but there is a reasonable weight limit. You can find the forms online at the medical school. If you decide on cremation sans med student scalpels, go directly to a crematory instead of via a funeral home to $ave at least 100%.
I just sat on a mock jury for an attorney representing an insurance company in a suit almost identical to this, but in a different state. When all was said and done, claims about benefits may or may not have been made but it all boils down to the written contract and it’s up to the consumer to read it and understand it before signing the contract.
There probably isn’t a swop clause, but they were probably told that there was.
If there isn’t a SWOP clause and Vicki told the couple there was, l’m all for nailing her to a cross with very rusty nails. If she lied, again, l wish her swift karma. Bitch.
Considering Vicki’s track record, I have my suspicions. Still, you have a point that we won’t know the full truth until the court can go through Joan Lile’s contract with a fine-tooth comb.
Hopefully, the judge is getting that comb ready now.
He doesn’t need a comb. He just needs to ask the defense to show evidence of a SWOP clause in the contract. Not there? Case Closed.
Thanks so much for explaining this for all of us. I’m actually reading all this from my “work event” on The Strip, so I’m about as frazzled as Shannon appeared to be in Jamaica (and much of the rest of last season).
Again, you’re doing us all such a great public service.
My sarcasm meter is beeping at me. You’re at a strip club aren’t you?
Not quite, but it did involve someone who’s been fighting a famed exotic dancer in court.
Actually, the defense can sit there the whole time and say nothing. It isn’t up to the defense to prove the Plaintiff’s claim. The burden is on the Plaintiff to prove every element of his/her case. So if she’s claiming all these breaches it’s up to her to prove her case. The contract itself will be presented by the Plaintiff and it will be up to her to prove or disprove the specific clause exists. The the defense will get to respond. It’s also unlikely emotional distress damages will be granted. It’s a high bar to meet and some onus lies on the Plaintiff to read her contract and she cannot impute that on someone else.
Note to self , call my Mom to check on her LTC insurance policy .
I currently live in an assisted living facility. The previous admin once told me that they had to reconsider my rent amount to see if I’m a “Valuable means of income” for them. So yeah, I got downgraded from a human being to a monetary figure. The health care system sucks monkey balls! I pray everyday that I can find another place to live, but I do need assistance in occasion.
Nadia, my heart really goes out to you. You are a treasure and should be treated like a queen. Please keep your head up. Something better will come along for you.
Nadia, you are very valuable. No person determines your worth. We are dealing with this for my mom. I’m sorry you were made to feel this way.
There’s a special place in hell for people that lie about cancer and cheat the elderly when they’re most vulnerable (allegedly).
This is a wake-up call for everyone to check their LTC insurance policies.
If you don’t get a LTC policy when you are young, 20s or 30s, you will pay a fortune if you are accepted at all. My solution is to just not get old so assisted suicide better become readily available in the next 20 years. ?
My mother has her insurance person on speed dial. I am not kidding. It is her biggest vice, if she can write a policy on someone or something she will. She calls him at least twice a week.
On the flip side, my friend who got his Masters Degree in creative writing from NYU was the guy who wrote all that small print on the bottom of insurance policies.
Well if there isn’t a SWOP clause & the insured was told ther was….there’s always Vicki’s agency Errors & Omissions insurance to go against. I was a licensed insurance agent for 20+ years and even I was put in a position to have to sue my husband’s life insurance company when he died. Oh the things that I learned in that 4 year period !! I won my case based on the contradictory wording in the policy that the insurance company first denied my claim….but it took 4 years and a damn good attorney who believed in my case to get there.
It is more often than not to just have Medi-Cal or Medi-Medi to go into a nursing home instead of having money that would need to be spent down after 100 days or a private plan with limited coverage. I always thought she was a “scammer” even from the beginning when she wasn’t making the big bucks but had that lavish lifestyle with the Coto home, that expensive grotto in the back yard, and how freely she spent money. It just seemed like alot for someone in insurance. Seeing her drive around in that big white Bentley and the high rent around the Irvine Spectrum. She sure spends lavishly. Also, not Asian. Wing is an English last name in my case.
She ran her business out of her home for years, also Don made very, very good money as well. This isn’t a case of the house that fraud built. I am not totally a Vickie fan but she has worked her ass off
Lol . . . Here we go again! Media is out to get her!
interesting update.
So basically, Vicki has been branding herself as something she doesn’t TECHNICALLY do herself. I get it. Yeah, home girl has the wrong person to sue, but I understand her frustrations. What a mess.
If you think about it, she does say people always need to buy insurance. In fact, I think she told her son last season when she had surgery that he didn’t need to be with her. She told him to go “sell insurance!! There is always somebody who needs to buy insurance!” That is a paraphrase and does not offer the usual Vicki shriek. Meaning, “selling” insurance is a lot like selling used cars. It’s not her policy, but who knows what was said, and I am sure it was a hard sell.
I do wonder in CA what the differences are (if any) between financial services and an insurance agent. As you stated well, Cho, I had always assumed she was insurance agent. It may just be semantics to help with this particular legal situation and to make her feel like a Wall Street type:) Can you imagine…
If you are trying to figure out which rip off Obama plan if any is right for you it helps to have someone explain the pros and cons of all the choices, the out of pocket expense limits etc. Under the government plan there are people who will help you for free if you know where to look.
There are many reasons to go to a financial planner. However, the name Coto INSURANCE and financial Planning seems misleading.
I believe in CA in order to be an insurance agent you have to get a certification or license to sell insurance. Same as a license to sell cars. Vicki may not be the one doing the financial planning or estate planning she probably has a licensed financial planner or estate planning attorney on staff to assist her clients. Vicki probably only holds a license to sell insurance. I guess she responded to a comment on Instagram today and she said she is not an insurance carrier and cannot decline a policy to an insured. This makes total sense since she is just the one who sells the carrier’s plan. I guess this carrier went out of business and now these people are going after Vicki. She’s really the intermediary in all of this and it sounds like these people are suing the wrong person. Not that I’m defending Vicki as a whole, but in this particular instance it sounds like she isn’t the proper defendant.
It sounds like to me, that Vickie markets herself as some kind of insurance expert, and someone who hooks up a person with the insurance they want and she advices that they need. So I could see her being included in the suit. I would imagine that all parties are being sued, and I dont blame this woman for being totally pissed if she was mislead after paying all those premiums, and thought it worked this way. I would think the attorney wouldnt have taken the case on, if there wasnt some evidence of misleading this couple about how it worked, or perhaps defrauded her by continuing to bill her, even though it contained that clause. Time will tell.