If your long-term care insurance claim has been denied, you may feel frustrated and unsure of what to do next. However, the good news is that you have the right to appeal the denial. Here is a step-by-step guide to help you through the appeals process:
Step 1: Review the denial letter
The first step in appealing a long-term care claim denial is to carefully review the denial letter you received from your insurance company. This letter should explain the reason for the denial and outline the specific policy provisions that led to the decision.
Step 2: Gather additional information
If you disagree with the denial, it’s important to gather additional information that supports your claim. This may include medical records, doctor’s notes, and any other documentation that supports your need for long-term care services.
Step 3: Consider hiring an attorney knowledgeable in long-term care insurance
If your appeal is denied, you may want to consider hiring an attorney early who specializes in long-term care insurance claims. An attorney can help you understand your rights and options, and will be able to assist you in appeals or legal action.
- Did you know that the contents of long-term care policies are often governed by a tax law (26 U.S. Code § 7702B) enacted by Congress in the 1990s?
- Did you know that not every state licenses assisted living facility?
- Did you know that many states do not regulate premiums on group employer offered long-term care insurance?
- Did you know that under at least one state law, failing to pay long-term care insurance benefits may be considered elder financial abuse?
- Do you know the difference between long-term care care insurance that provides reimbursement vs. indemnity vs. cash benefit polices?
- Do you understand how hybrid long-term care/life insurance policies pay?
- Do you understand how hybrid long term care/annuity policies pay?
Step 4: Prepare a written appeal
Once you have gathered the necessary information, you should prepare a written appeal. This letter should clearly state why you believe the denial was incorrect and provide evidence to support your claim. Be sure to include a copy of the denial letter and all supporting documentation.
Step 5: Submit the written appeal
Submit your written appeal to the insurance company, along with all supporting documentation. Be sure to keep a copy of the appeal and all related materials for your records.
Step 6: Wait for a response
After you have submitted your appeal, the insurance company will review it and respond. This process can take several weeks or even months, so it’s important to be patient.
Step 7: Appeal to the state insurance commissioner
If your appeal is denied, you can file a complaint with the state insurance commissioner. This can be done by submitting a written complaint to the insurance commissioner’s office. The insurance commissioner will then review your case and make a determination.
Step 8: Consider filing a lawsuit
If your complaint to the state insurance commissioner is not successful, you may consider filing a lawsuit. This is usually a last resort and should only be done after all other options have been exhausted.
Conclusion
In conclusion, appealing a long-term care claim denial can be a complex and time-consuming process, but it’s important to remember that you have the right to appeal. By following these steps and seeking the help of an attorney if necessary, you can increase your chances of getting the long-term care coverage you need.
