How Can a Long-Term Care Insurance Attorney Help?
A skilled long-term care insurance attorney
may take away some of the worry and fear in dealing with filing a claim or a denial
when you are seeking long-term care insurance benefits. An experienced attorney can guide you through the claims process increasing the likelihood that the insurance company will pay the claim. Learn about all the legal options available to you. During a consultation, we will:
What Is Long-Term Care Insurance?
Long-term care insurance typically pays benefits to you or on your behalf when you suffer from:
- Chronic illness,
- Cognitive impairment, or
- Other inability to engage in activities of daily living (ADLs).
While anyone can file a claim on a long-term care policy
, it’s the elderly who need these policies the most. Long-term care policies may include in-home services assisting with ADLs. Sometimes the policies provide for nursing home care as well as care in assisted living facilities. Insurance policies purchased for loved ones or yourself that finance long-term care cover a wide variety of services that are not covered by typical health insurance policies or Medicare.
In recent years, people have become more and more aware of how easily long-term care services can wipe out elderly citizens’ life savings. Long-term care insurance can be expensive. It also often provides limited benefits, with restrictions and conditions that may only cover a small percentage of total long-term care costs.
What Determines Eligibility for LTC Benefits?
Each policy is different, and the language of your contract will determine whether or not you or your loved one is eligible for benefits. Older policies use language such as “medical necessity” while the newer policies, which are more exclusive, use language detailing an inability to perform two or more activities required for daily living. This can include an inability to bathe, prepare food, dress, or clean the home. Another trigger for coverage is often based on cognitive impairment. Having impairments that restrict a claimant’s ability to perform necessary living activities isn’t enough. A physician is required to sign off on these impairments and then recommend a care provider who will meet the claimant’s individual needs.
What Can I Expect Once I’ve Submitted My Claim?
The Insurer May Conduct an Assessment
Claims for long-term care should not be denied unless the insurance company performs an in-person assessment of the claimant. This assessment must be conducted by a licensed health-care provider. Some states require that any policy issued before 2000 has a clause that requires the insurance provider to conduct this assessment in person as opposed to over the phone.
Insurance companies do not make money paying out claims. In cases where there is any ambiguity in the situation or much of the claimant’s argument is built from anecdotes by loved ones, the insurance company may decide that the claimant’s situation does not rise to the level for triggering payments. You should be aware that some unscrupulous insurance companies may:
- Interpret the language of your policy in the best interests of their bottom line;
- Deny receiving documents that you know you sent them;
- Use doctors who are paid by them to deny otherwise valid claims; and
- Not tell you about benefits you’re entitled to under the terms of your policy.
In some cases, insurance companies get away with this behavior when policyholders give up on the claims process. They figure that those who “really need” the benefits will continue to fight.
How a Long-Term Care Insurance Attorney Can Help
A long-term insurance care attorney understands the regulations surrounding these policies and can help you fight against bad faith denials. We ensure that your claim files provide sufficient evidence proving that your condition limits your ability to perform the activities of daily living. We also make sure that a care plan is in place to help you with those tasks.
If the long-term care insurance company is denying your claim, stalling, or otherwise acting in bad faith, talk to a Boston long-term care insurance attorney at Jonathan F. Feigenbaum, Esquire
. We can help you review your policy, navigate roadblocks put up by the insurance company, and advise you of your options. Contact us today for a complimentary assessment of your claim.