Glastonbury Health Care Center sued Carmine Esposito for breach of contract, negligence, promissory estoppel, and fraudulent misrepresentation to hold him responsible for over $100k in nursing home bills. Today we will review the claim for promissory estoppel.

A claim for Promissory Estoppel exists when “[a] promise which the promissor should reasonably expect to induce action or forbearance on the part of the promissee . . . and which does induce such action or forbearance is binding if justice can be avoided only by enforcement of the promise.” A critical element of promissory estoppel is the existence of a clear and definite promise which a promissor could reasonably have expected to induce reliance.

In this case, the court found that Carmine Esposito wanted Josephine’s care at Glastonbury Health Care Center to be paid for by Connecticut Medicaid. Carmine knew that a requirement of Connecticut Medicaid was that the assets of Josephine do not exceed $1,600.00. He knew that Glastonbury Health Care Center would not accept Josephine without her being approved for Medicaid. Carmine agreed to apply for Josephine’s Medicaid. He consented by his silence to accept the obligation of a responsible party (as defined in the admissions contract) to obtain and maintain Josephine’s eligibility for Medicaid. The Court concluded Carmine reasonably expected that Glastonbury Health Care Center would rely upon that conduct and promise to accept Josephine as a resident. Glastonbury Health Care Center did rely on Carmine’s conduct and promise. Carmine Esposito failed to obtain approval of Josephine’s application from April 1, 1998 to September 2000. As a consequence, Glastonbury Health Care Center lost Connecticut Medicaid payments for that period. Those facts establish the claim for promissory estoppel.

In response to the nursing home’s claim, Carmine responded that Glastonbury Health Care Center failed to exercise due diligence to sustain the truth as to Josephine’s eligibility for Medicaid. Relying on a 1982 case, the Court concludes that Glastonbury Health Care Center did not have a duty to exercise due diligence to determine that Carmine had made false promises.

In a second attempt to defeat the nursing home’s claim of estoppel, Carmine claimed that his silence during the nursing home admission process could not create the basis for the nursing home’s estoppel claim unless he had a duty to speak. The court concluded that since Carmine was seeking to have Josephine accepted by the nursing home as a Medicaid beneficiary, knew the nursing home would not accept Josephine without her Medicaid application being approved, and was apprised of his obligation to obtain and maintain her eligibility as a condition for her acceptance, he had the duty to object to that obligation. The court found that this duty to speak and Carmine’s failure to do so form the basis for estoppel.

This is the third example of Carmine Esposito’s big mistakes in applying for his mother’s Connecticut Medicaid benefits. His mistakes cost him over $100,000 of his own funds. A Connecticut Medicaid Attorney could have saved Carmine from this mess for a lot less than what the Court ordered him to pay the nursing home. A Connecticut Medicaid Attorney can help your family avoid Medicaid mistakes and being held personally responsible for nursing home bills.

Related posts:

1. How To Get Sued By a Nursing Home: Negligence
2. Nursing Home Wins $102,574 From Resident’s Son
3. Is Your Delay Causing a Breach of Contract?

In addition to the breach of nursing home admissions contract claims, Glastonbury Health Care Center claimed Carmine Esposito was negligent in getting Josephine’s application for Connecticut Medicaid approved. In order for the Court to find Carmine negligent, it has to find Carmine owed a duty to Glastonbury Health Care Center to exercise reasonable care. If Carmine owed the nursing home a duty, then it must also find Carmine’s breach of that duty caused actual injury to Glastonbury Health Care Center.

The Court found Carmine Esposito owed Glastonbury Health Care Center a duty to exercise reasonable care for many of the same reasons they found him bound to the terms of an admissions contract he never signed. Specifically, the court found:

1. Carmine prepared the application for Connecticut Medicaid benefits;
2. Lucy Higgins, from Glastonbury Health Care Center, informed Carmine of his obligation to provide all information requested by DSS and to “promptly and expeditiously establish and maintain eligibility for Medicaid assistance”;
3. Carmine knew Glastonbury Health Care Center would not admit his mother unless he accepted the obligation described in #3;
4. Carmine was silent and the Court found his silence indicated consent to these obligations.

The Court found Carmine owed a duty to the Glastonbury Health Care Center to obtain Connecticut Medicaid benefits for his mother, did he breach his duty?

The Court determined that he did fail to exercise reasonable care for the following reasons:

1. Carmine failed to liquidate a bond Josephine owned in a reasonable amount of time;
2. Carmine neglected to properly apply the funds of a bank account Josephine owned within a reasonable time;
3. Carmine and his attorney failed to respond to DSS requests for information on the bond and bank account.

Carmine tried to go through the Connecticut Medicaid application and eligibility process alone and he messed up. His mistakes cost him over $100,000 that the Court determined he owed to Glastonbury Health Care Center. Carmine might have been able to save himself the $100,000 (and the litigation fees) if he had chosen to work with an experienced Connecticut Medicaid Attorney.

Related posts:

1. How To Get Sued By a Nursing Home: Estoppel
2. Nursing Home Wins $102,574 From Resident’s Son
3. Is Your Delay Causing a Breach of Contract?

Connecticut Statute 19a-535 sets forth the requirements and procedures for discharge of a resident from a Connecticut Nursing Home. The statute allows a nursing home to discharge a self-pay resident “for his nonpayment or arrearage of more than fifteen days of the per diem facility room rate.”

15 days is all you get, after that the nursing home does have the ability to pursue discharge for non-payment.

This is important because some families drag their feet or never even finish satisfying the requirements for Connecticut Medicaid eligibility once their loved one is admitted into a Connecticut Nursing Home. If they do, and their Medicaid application is denied, they are making a big gamble that 1) the nursing home will not discharge the loved one, and 2) the nursing home will not pursue the family members for breach of the admissions contract.

A Connecticut Medicaid Attorney can help protect your loved one and your family from discharge and personal liability for nursing home bills. However, it is often too late after the mistakes have been made because there are some actions that simply can not be undone. Get it right the first time.

Related posts:

1. Get Control
2. Denied for Medicaid – Now What?
3. Critical Connecticut Medicaid Mistake #3

Blanche Morin was a patient at Newington Health Care Center. The Probate Court determined Blanche was unable to manage her assets and appointed her daughter, Cynthia Tracy, as Conservator of the Person and Estate for Blanche Morin. As a result, Cynthia was responsible for managing Blanche’s assets and accounts.

With money running out quickly, Cynthia applied for Connecticut Medicaid to pay for Blanche’s care.

Unfortunately, Cynthia did not act as quick as she was required to do by law and there was a gap between when her mother’s money ran out and when Connecticut Title 19 Medicaid nursing home benefits started paying her mother’s costs.

Unable to receive payment from anyone, Newington Health Care Center filed a lawsuit against Cynthia to recover $15,879.

Cynthia Tracy thought she would never be sued by the Newington Health Care Center for the relatively small amount of $15,879. She was, and you can be too.

If you want to avoid the simple mistakes that lead to family members being sued, or if you are already being threatened with a lawsuit by a nursing home, speak with a Connecticut Medicaid Attorney today.

Related posts:

1. How To Get Sued By a Nursing Home: Negligence
2. How To Get Sued By a Nursing Home: Estoppel
3. Nursing Home Wins $102,574 From Resident’s Son