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Long-Term Care Insurance Policy Fine Print

Understanding the Fine Print of Your Long-Term Care Insurance Policy

Most people who purchase long-term care insurance think that they are making a wise investment that will protect them from financial hardship. However, many of these policies include complicated terms and conditions that can result in denied claims, delays, and intense frustration.

If you are considering filing a claim, it’s important to understand the fine print of your long-term care insurance policy. Below, the experienced team at Jonathan M. Feigenbaum, Esquire outlines what to look for, and when you should consult with an LTC lawyer.

What Is in the Fine Print of My Long-Term Care Insurance Policy?

When you review the documents that make up a long-term care insurance plan, you will find an array of complicated and highly technical language that may seem almost undecipherable. Welcome to the world of insurance policy fine print. Unfortunately, the “fine print” in long-term care insurance or the interpretation of ambiguous language may allow an insurance company to deny your benefits. But that doesn’t mean that you have to take NO coverage as the final answer. Ambiguous insurance policy language in the end is often advantageous to the insurance policy owner, because Courts will generally construe ambiguous language to help-out the insurance policy owner.

When many of our loved ones purchased their long-term care policies, highly restrictive fine print was the norm. Some policies won’t cover adult day care, assisted living, or services that let someone “age in place.” Others include eligibility criteria that are difficult to understand or daunting to meet.

Remember, the insurance company will pay for certain expenses if you meet the terms set out in the policy. Unfortunately, the “fine print” in these policies can be very technical and difficult to understand. Many policies contain:

  • Detailed benefit triggers, which you must meet before you qualify for long-term care benefits
  • Exclusions and loopholes that disqualify you from benefits
  • Waiting periods before you are eligible for coverage, sometimes called “elimination periods”
  • Limitations on what types of services are covered
  • Rules concerning the specific licensure of covered facilities
  • Specific claim and appeals processes
  • Strict filing deadlines

How Can a Long-Term Care Lawyer Help?

At Jonathan M. Feigenbaum, Esquire, we understand that interpreting a long-term care insurance policy’s terms and conditions is difficult even under the best of circumstances. If you’re struggling with the difficult decision about whether to apply for long-term care or file an appeal if your claim was denied, the task may seem virtually impossible.

Unfortunately, even one mistake can cause a denial of long-term care coverage. When you work with an experienced long-term care lawyer, we can help you understand what all that fine print actually means — and help you assess your eligibility under the policy.

An LTC attorney can review your policy’s documents, including the extensive Plan Document and its Summary Plan Description, interpret its language, and apply it to your exact circumstances. This process may include researching case law, statutes, and regulations that impact the legality of the policy’s language. We can also help you find a facility or caregiver that meets the policy’s complicated requirements and reflects your loved one’s specific needs.

Request a Complimentary Assessment of Your Claim With Guidance on the Next Steps You Need to Take With an Experienced LTC Lawyer

If you’re not sure exactly what your long-term insurance policy’s requirements are, it’s time to consult with an LTC insurance attorney. When you request a consultation with a lawyer at Jonathan M. Feigenbaum, Esquire, we will give you the time you deserve, helping you read and understand the plan’s complicated language and identify practical next steps that can help you and your loved one.

We can also guide you through the challenging process of filing a long-term care insurance claim, fighting through all of the insurance company’s red tape, and building effective strategies that aim to get you the financial support you deserve.

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