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.
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.