Introduction

This appeal is the latest chapter in a series of disputes over home health care benefits tied to two individual insurance policies issued by Brighthouse Life Insurance Company to William T. Jackling and his late wife. After Brighthouse denied several benefit claims, two lawsuits followed: (1) one brought by Jackling in his capacity as executor of his wife’s estate (the “Estate of Jackling” action), and (2) the present action, originally filed pro se by Jackling on his own behalf. The district court granted summary judgment to Brighthouse in both matters; the first was affirmed by the Second Circuit in 2024, and the second—the decision discussed here—has now also been affirmed.

On appeal, the appellant advanced three arguments: (i) as a pro se litigant, he was not adequately warned about the nature and consequences of summary judgment under Vital v. Interfaith Medical Center; (ii) his claims were not barred by collateral estoppel; and (iii) his policy covers household services rendered by unlicensed home health aides. The Second Circuit resolved the case on a threshold contract-interpretation issue, holding that the policy requires the use of a licensed agency or licensed/certified aides; unlicensed/un-certified aides are not covered. Because that holding was dispositive, the court declined to reach the Vital notice and collateral estoppel issues.

Although issued as a “Summary Order” and therefore nonprecedential under the Second Circuit’s Local Rule 32.1.1, the decision provides a careful, text-driven reading of a home health care reimbursement provision that will be instructive to insurers, policyholders, and practitioners dealing with similar policy language—particularly long-term care riders and home health benefits embedded in life insurance contracts.

Summary of the Opinion

• Core holding: The Brighthouse home health care reimbursement provision requires either:
  • services provided through a licensed home health care agency (in states that require agency licensing), or
  • services of a licensed or certified home health aide when the aide does not report through a licensed/certified agency, provided the policy’s care coordination and plan-of-care conditions are met.
  Unlicensed and uncertified aides are not covered. This conclusion applies equally to “home health aide services,” “home hospice services,” and “homemaker services” described in the policy.
• Method: The court applied standard principles of insurance contract interpretation: start with the policy’s plain language; give words their ordinary meaning; avoid absurd results; and construe ambiguities (especially in exclusions) in favor of the insured. Finding the text clear, the court read the two adjacent provisions in subsection 7 to set out alternative, not cumulative or conflicting, pathways to covered care.
• Other issues not reached: The panel did not decide whether the district court satisfied the Vital notice requirement for pro se litigants or whether collateral estoppel bars the claims. Notably, the court suggested it was “hardly clear” that adequate Vital notice was given, but that observation did not alter the outcome here.
• Result: Affirmance of summary judgment for Brighthouse.

Detailed Analysis

1) Precedents Cited and How They Informed the Decision

• Village of Sylvan Beach v. Travelers Indemnity Co., 55 F.3d 114 (2d Cir. 1995): The court reiterated that insurance contracts are interpreted by their “clear language,” and ambiguities—particularly in exclusions—are resolved in favor of insureds. Here, the panel found the operative language clear and therefore applied its ordinary meaning.
• Newmont Mines Ltd. v. Hanover Ins. Co., 784 F.2d 127 (2d Cir. 1986): Words in an insurance policy receive their ordinary meanings, and interpretations producing absurd results are avoided. This anchored the court’s refusal to stretch the “if licensing is required by the state” clause to authorize reimbursement for unlicensed aides—an interpretation that would clash with the policy’s structure requiring licensed providers.
• Duane Reade, Inc. v. St. Paul Fire & Marine Ins. Co., 600 F.3d 190 (2d Cir. 2010): Whether language is ambiguous is a legal question reviewed de novo. The panel applied de novo review in concluding the text was unambiguous.
• Vital v. Interfaith Medical Center, 168 F.3d 615 (2d Cir. 1999): Though not outcome-determinative, the panel referenced Vital’s requirement to ensure pro se litigants understand the nature and consequences of summary judgment. The court’s aside suggests vigilance is still required of district courts on this front.
• Estate of Jackling litigation: The panel noted the prior Western District of New York case and this Court’s 2024 affirmance (No. 22-1703, 2024 WL 4100518). While the district court also relied on collateral estoppel in this case, the panel affirmed on the alternative contract-interpretation ground.

2) The Court’s Legal Reasoning

The policy’s home health care reimbursement provision includes two adjacent parts within subsection 7:

1. Agency-based pathway: “Services of a licensed home health care agency, if licensing is required by the state, to provide: (a) home health aide services; (b) home hospice services; (c) homemaker services … performed by any of the individuals described above.” The court read “if licensing is required by the state” as a condition on the agency—i.e., where a state licenses agencies, the agency must hold that license.
2. Independent-aide pathway: “Services of a licensed or certified home health aide who does not report through a licensed or certified home health agency will be covered” if two conditions are met (use of the Care Coordination Benefit and a Licensed Health Care Practitioner’s written plan of care certifying the need and approving the services of a certified aide).

Rejecting the appellant’s construction, the court held that the second sentence does not relax any licensing/certification requirement; instead, it offers an alternative route to coverage when the aide does not report through an agency. Importantly:

• The modifier “if licensing is required by the state” applies to agencies only, not to aides. It ensures agencies comply with state licensing where such regimes exist; it does not authorize payment to unlicensed aides.
• The structure of the benefit confirms a consistent licensing scheme. The panel emphasized that the six subsections preceding subsection 7 all require licensed providers (e.g., licensed nurse, licensed physical therapist). Reading subsection 7 to permit unlicensed aides would disrupt that coherent framework.
• No ambiguity to trigger contra proferentem. Because the court found the text unambiguous, it did not invoke the principle of construing ambiguities in favor of the insured.

Thus, whether through a licensed agency (where an agency licensing regime exists) or as an independent provider, the aide must be licensed or certified for services to be reimbursable. Unlicensed and uncertified aides fall outside the coverage grant. This reading also governs “homemaker services,” which the policy covers only when performed by the individuals described (i.e., licensed/certified personnel) and during a visit primarily providing custodial/personal care.

3) Issues Left Unresolved (and Why)

• Vital notice: The panel pointedly observed it was “hardly clear” the pro se litigant received the required notice of the nature and consequences of summary judgment. Nonetheless, because the coverage question was dispositive, the court declined to decide the Vital issue.
• Collateral estoppel: The district court alternatively held the claims were precluded by prior litigation involving the wife’s policy. The panel did not reach this issue, again because the coverage determination resolved the case.

4) Potential Impact

Although nonprecedential, the order has practical significance:

• For policyholders:
  • Expect strict adherence to licensing/certification requirements for home health aide services—even for seemingly “non-medical” homemaker tasks, which the policy ties to licensed/certified providers during a qualifying visit.
  • If employing independent aides (not through an agency), confirm that aides are licensed or certified, and ensure care coordination and a compliant plan of care are in place.
• For insurers:
  • The decision endorses a structural, text-first approach to integrated benefit provisions, reinforcing the legitimacy of licensure/certification conditions in home health care benefits.
  • Drafting clarity matters: syntax that delineates whether state licensing clauses modify agencies or aides can avoid disputes.
• For courts:
  • The order underscores that courts may affirm on any dispositive ground supported by the record, avoiding thorny procedural or preclusion issues when clear policy language resolves the case.
  • The Vital discussion, though dicta, is a reminder to ensure robust notice to pro se litigants at the summary judgment stage.
• For long-term care and similar benefits markets:
  • As more policies include home health and homemaker benefits, this reading encourages professionalized, credentialed service delivery, elevating oversight but potentially raising out-of-pocket costs for insureds who have relied on informal or family-based care.

Complex Concepts Simplified

• Summary Order (Second Circuit): A nonprecedential disposition. It can be cited under FRAP 32.1 and Local Rule 32.1.1, but it does not bind future panels. Parties citing it must label it as a “summary order.”
• Summary Judgment: A procedural device allowing judgment without trial when no genuine dispute of material fact exists and the movant is entitled to judgment as a matter of law. Courts must ensure pro se parties understand the consequences of failing to oppose properly (the Vital notice requirement).
• Collateral Estoppel (Issue Preclusion): Prevents re-litigation of an issue actually litigated and necessarily decided in a prior action involving the same party (or its privy), provided there was a full and fair opportunity to litigate. The Second Circuit did not decide this here.
• Licensed vs. Certified Aides: “Licensed” implies a state-issued license; “certified” is a credentialing process that may differ by jurisdiction. The policy covers aides who are either licensed or certified; unlicensed and uncertified aides are not covered.
• Home Health Care Agency Licensing: Some states license agencies that coordinate and employ aides. The policy requires the agency to be licensed where state law so requires.
• Care Coordination Benefit and Plan of Care: Many home health benefits require insureds to use a care coordination program and maintain a written plan of care from a Licensed Health Care Practitioner, certifying the need for services and approving the aide’s services.
• Homemaker Services Limitation: In this policy, tasks like meal preparation or light housekeeping are reimbursable only when prescribed in a plan of care and performed during a visit primarily providing custodial/personal care by covered (licensed/certified) individuals.

Note on Precedential Status

This decision is a Second Circuit summary order. It may be cited as persuasive authority but does not have precedential effect. See FRAP 32.1 and Local Rule 32.1.1.

Conclusion

The Second Circuit affirmed summary judgment in favor of Brighthouse by adopting a straightforward, textually anchored construction of the policy’s home health care reimbursement provisions. The court held that the policy requires the use of a licensed agency (where agency licensing exists) or a licensed/certified aide when the aide operates outside an agency, with applicable care coordination and plan-of-care requirements. Unlicensed, uncertified aides fall outside the coverage grant, even when performing homemaker services tied to custodial care.

While the panel did not reach the Vital notice or collateral estoppel issues, its observation about the adequacy of notice to pro se litigants is a cautionary signal for district courts. For policymakers and drafters, the decision underscores the importance of clear syntactic signaling in benefits provisions to avoid misreadings about who must be licensed and under what conditions. For insureds, the practical takeaway is equally clear: to secure reimbursement for home health services under comparable policy language, engage either a licensed agency or a licensed/certified aide and ensure the policy’s care coordination and plan-of-care prerequisites are meticulously satisfied.

Key Takeaways

• Unlicensed and uncertified home health aides are not covered under the Brighthouse policy’s home health care benefit.
• Coverage flows either through a licensed agency (where required) or through a licensed/certified aide operating independently, with care coordination and a proper plan of care.
• Homemaker services are reimbursable only when performed by covered licensed/certified individuals as part of a qualifying custodial/personal care visit and prescribed in a plan of care.
• Although nonprecedential, the order provides persuasive guidance on parsing adjacent policy clauses and respecting the policy’s structural logic requiring licensed providers.
• District courts should continue to heed Vital’s notice requirements in pro se summary judgment contexts, as the panel hinted potential deficiencies here.

Citations

• Jackling v. Brighthouse Life Ins. Co., No. 23-7309 (2d Cir. Oct. 15, 2025) (Summary Order).
• Jackling v. Brighthouse Life Ins. Co. (Estate of Jackling), No. 20-C-6899-MJP, 2022 WL 2669924 (W.D.N.Y. July 10, 2022), aff’d, No. 22-1703, 2024 WL 4100518 (2d Cir. Sept. 6, 2024).
• Vill. of Sylvan Beach v. Travelers Indem. Co., 55 F.3d 114 (2d Cir. 1995).
• Newmont Mines Ltd. v. Hanover Ins. Co., 784 F.2d 127 (2d Cir. 1986).
• Duane Reade, Inc. v. St. Paul Fire & Marine Ins. Co., 600 F.3d 190 (2d Cir. 2010).
• Vital v. Interfaith Med. Ctr., 168 F.3d 615 (2d Cir. 1999).