The 11th Circuit is back in full swing releasing opinions after a brief hiatus during the holiday season. Among the decisions handed down last week was Storcher v. Guarantee Trust Life Insurance Company, a decision on insurance coverage under a home health care policy.

At issue was whether a policy covering “[v]isits by a Home Health Aide to provide custodial care and other personal health care services specifically ordered by a Doctor” required the insurer to pay for care provided by the staff of an assisted living facility to a resident. The Eleventh Circuit held that it did.

That result may seem odd given that we often think of “home health care” as care provided to a patient living independently in a house or apartment, as contrasted with care administered in a hospital, nursing home, or similar facility. Assisted living facilities would seem to fall somewhere in between those alternatives.

But the court didn’t confront the status of assisted living facilities head on, as the insurer conceded that the care was administered to Storcher was in his “home.” The opinion does not disclose the policy’s definition of “home,” but I suspect that this concession was necessitated by a broad definition that (perhaps unintentionally) could not reasonably be said to exclude assisted living facilities.

Instead, the insurer tried to raise the issue from the other side, contesting coverage by arguing that the assisted living facility staff members who provided the care were not “Home Health Aides,” i.e., employees of a “Home Health Care Agency.” Unfortunately for the carrier (and fortunately for Storcher), however, that term was also broadly defined to include “a service or agency which is licensed by or legally operated in your state” except for Employment Agencies and Nurse Registries.

The insurer argued that this definition, and its exclusion of the two types of entities that were allowed to provide home health care without a license at the time the policy was issued, showed that the policy only covered care provided by licensed home health agencies. And the facility where Storcher was living was licensed as an assisted living facility, not a home health agency. (After the policy was issued, the home health agency statute, Florida Statutes Section 400.464, was amended to specifically exempt assisted living facilities from licensing under that statute so long as they are licensed as assisted living facilities.) So the carrier argued that since the assisted living facility wasn’t licensed as a home health agency, the care it provided wasn’t covered. 

But as in many cases where coverage is contested based on policy language that was assertedly intended to track statutory language, the 11th Circuit was unwilling to entertain that argument in the face of broad policy language that the court felt was unambiguous and had a simple meaning that did not explicitly so limit coverage.