In short: In Walker v. Bankers Life, the Second DCA reversed summary judgment for a long-term care insurer that denied home health benefits because the aide was independent rather than working through a licensed agency or nurse registry. The 2-1 majority held the restriction was an exclusion that section 627.94071(6) prohibits.
The Facts
In 1996 Bankers Life issued Fred G. Walker a long-term care policy with home health care coverage, renewed every year. In 2015 he hired an independent certified nursing assistant to provide home health care. Bankers Life denied the claim, saying the policy covered home health services only when delivered through a licensed home health agency or a nurse registry under chapter 400.
Bankers Life conceded the caregiver qualified as a home health aide under Florida law. After Walker’s death, his estate’s personal representatives sued. The trial court granted final summary judgment for Bankers Life, reasoning that the statute did not stop the insurer from requiring a care protocol the insured accepted when he bought the policy.
The Decision
The Second District reversed on December 4, 2024. Because a renewal creates a new contract, the 2015 version of section 627.94071 governed the policy. That statute requires home health benefits to meet minimum standards and bars excluding coverage for personal care services provided by a home health aide. The majority held that conditioning coverage on agency or registry affiliation operated as an exclusion of care by a qualified independent aide, which the statute forbids. Exclusions are read strictly against the insurer.
Judge Labrit dissented. In her view, the policy was unambiguous, and the statute distinguishes between limiting and excluding benefits, so a requirement that aides work through an agency or registry was a permissible limit rather than a prohibited exclusion. The case went back to the trial court for further proceedings.
The Law
section 627.94071 sets minimum standards for home health care benefits in Florida long-term care policies. A policy may not exclude benefits by, among other things, requiring a licensed home health agency to provide services a licensed nurse registry can provide (subsection (5)), excluding personal care services provided by a home health aide (subsection (6)), or requiring a higher level of licensure than the service needs (subsection (7)).
Courts treat each annual renewal of an insurance policy as a new contract, so the statute in effect at renewal can apply to an older policy form. Exclusions and restrictions on statutorily mandated coverage are construed against the insurer.
Current law (2026): Section 627.94071 (2026) text unchanged since 1997 (ch. 97-179); subsection (6) still prohibits excluding coverage for personal care services provided by a home health aide.
Lessons
- If a long-term care insurer denies home health benefits because the caregiver is independent, check section 627.94071 before accepting the denial.
- Old policies are not frozen in time; annual renewals can bring them under the statute in effect at renewal.
- Keep records showing the caregiver’s certification and the services actually provided.
- Personal representatives can pursue unpaid long-term care benefits after the insured’s death.
Source: Walker v. Bankers Life & Casualty Co., No. 2D2023-2187 — Fla. 3d DCA (December 4, 2024).
Watch the Oral Argument
This is the recording of the actual oral argument, posted on the channel. What lawyers and judges say at argument is not the ruling; the decision is summarized above.
Long-Term Care Insurer Denies Independent CNA Care | Estate of Walker v. Bankers Life, 2D23-2187
Go Deeper
- Florida's Vulnerable Adult Law: Exploitation Under Chapters 415 and 825
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- How to Protect Elderly Parents From Scams and Financial Exploitation in Florida
Frequently Asked Questions
Does long-term care insurance cover an independent caregiver in Florida?
It may. In Walker v. Bankers Life, the Second DCA held that a policy could not deny home health benefits just because a qualified home health aide worked independently rather than through a licensed agency or nurse registry, because section 627.94071(6) bars excluding personal care by a home health aide.
What does section 627.94071 require?
It sets minimum standards for home health benefits in Florida long-term care policies. Policies may not exclude benefits by requiring skilled nursing need, limiting care to nurses, requiring an agency where a registry would do, excluding home health aide personal care, or requiring higher licensure than the service needs, among other listed restrictions.
Does a new law apply to an old long-term care policy?
It can. In Walker, the policy was issued in 1996 but renewed yearly, and the court applied the rule that a renewal creates a new contract, so the 2015 statute governed. The answer depends on the policy and renewal history, so review both.
Can an estate sue a long-term care insurer after the insured dies?
Yes. In Walker, the insured’s personal representatives brought the claim for denied home health benefits on behalf of the estate. A personal representative can generally pursue contract claims the decedent had, subject to deadlines in the policy and statutes of limitation.
Talk to a Florida probate litigation lawyer
Weidner Law, P.A. handles Florida probate litigation and appeals from St. Petersburg. If you need a probate litigation lawyer, call (727) 954-8752 or email weidner@mattweidnerlaw.com.
Read the law yourself, free: the full Florida Probate Code and Probate Rules and the Florida Trust Code are on floridarules.net.
This article is general information about Florida law, not legal advice about your situation. Reading it, watching the videos, or contacting the firm does not create an attorney-client relationship. Every case turns on its own facts, and past results do not guarantee a similar outcome. The hiring of a lawyer is an important decision that should not be based solely upon advertisements.
