Did You or Your Loved One’s Long Term Care Application Get Denied?
If you or a loved one applied for coverage under a Long Term Care policy and were denied or if your claim for long term care benefits is not being decided in a timely manner, we can help. For two decades, we have fought back against insurance companies for people when their claims are either wrongfully denied or are being delayed. If your claim for long term care is like this, call our office to speak with an LTD attorney and learn about your options. The call is free and there is no obligation or cost to do so.
Long term care insurance is incredibly expensive, and yet when needed most, it often appears worthless. Care that should trigger this coverage is also incredibly expensive, and often can ruin a family financially. Securing your long term care insurance benefits is crucial.
People are stunned when their long term care claims are denied, naively believing that paying heavy premiums would make the claim readily payable. Many companies have completely stopped selling Long Term Care Policy Insurance because they were losing money due to high incidence of claims. Those companies who still sell long term care insurance only sell to people with extraordinarily good health, and who can afford the high premiums. And yet they still do not pay.
If you were smart enough – or just lucky – to purchase a long-term care insurance policy years ago, before the insurance sector tightened up on selling policies, you may face an uphill battle when trying to make a claim. Arm yourself and be ready to battle. This is a battle you don’t want to take on by yourself, and you don’t have to. The Newfield Law Group has for decades handled these cases, and our experienced and aggressive attorneys know how to fight back against insurance company tactics that have been developed over many years.
As more Americans need care from a nursing facility or a home health care aide, they are finding out that the insurance companies they counted on seem to be determined to pay as little as possible or not at all. The Newfield Law Group represents people just like you who paid premiums for decades to protect themselves and their savings from the exorbitant costs of long-term care.
Why Was My Long-Term Care Insurance Coverage Denied?
While there are many different tactics used by long-term care insurance companies to deny claims, the underlying reason for the denials and delays are two-fold: the insurance companies are chasing profits and doing everything possible to mitigate liability.
When long-term care insurance policies were originally sold, the insurance companies’ actuaries and economists expected the policies to be profitable. Over the years, improvements in medical care and medicines extended the length of the average American’s lifespan, while dramatically increasing the cost of healthcare. Paying benefits on long-term care policies has become less profitable for the insurance companies, which is why many insurance companies have sold their long-term care insurance divisions. Those who are left are doing everything they can to maximize profits for shareholders. Your claim is their unwanted overhead.
Despite this, claims are being paid out at higher amounts each year.
Can You Fight Back on a Denied Claim?
You can fight back when a claim is denied, when the long-term care insurance company is asking for an overly burdensome amount of paperwork, or if the company is delaying paying benefits.
This is a classic David vs. Goliath scenario that you don’t want to take on by yourself. Long-term care insurance companies have deep pockets, many law firms to represent them, and doctors and nurses on retainer to declare that you or a loved one do not qualify for care. You need an aggressive insurance law firm, with the experience and the tenacity to fight back.
A long-term care insurance policy is a contract between the claimant and the insurance company. Like many contracts, the long-term care policy is dense with legal complexities and is difficult for a layperson to understand.
Note that every situation is different, and we can explore them with you during a free consultation – call to learn how we can help.
We know it’s not fair, but it’s true: if the insurance company gets a call or a letter from a law firm, rather than a claimant, the response will be different.
Here are the most common reasons for a long-term care claim to be denied:
There are six activities of daily living (ADL), and claimants need to be able to prove that they are medically unable to perform at least two of them.
- Bathing, including taking a shower, brushing teeth, and grooming unassisted.
- Getting dressed and undressed.
- Meal preparation and eating
- Toileting and continence – including control and hygiene.
- Functional Transferring – walking to and from rooms in your home
- Getting in and out of bed safely
Typically, long-term care insurance for nursing home costs requires that an individual be unable to perform two or more of the six ADLs. Coverage all depends upon the language in your policy and the long-term care insurance company’s determination of whether or not you are truly unable to care for yourself and satisfy the criteria outlined in the specific policy.
Activities of Daily Living or ADL
Proper Licensure of Facility as an “Eligible Care Provider”
One of the provisions used to deny claims is the licensing status of the facility where long-term care is being provided. It is extremely important to review the policy and be sure that the facility under consideration will be covered by the policy. Don’t sign any contracts with the nursing home without finding out the facility’s licensing status.
Be sure the facility meets the criteria set in the long-term care policy. It may have language that indicates broad coverage for nursing homes, limited coverage for assisted living, or licensed home care with a properly licensed agency.
What if The Facility Is Not Properly Licensed?
The company running the nursing home or assisted living facility must prove to the long-term insurance company that it is an “eligible care provider.” The licensing or criteria sometimes depends on having the appropriate staffing and specific services, along with the necessary state licensing.
Do You Have a Plan for Care?
There is an assessment of your health condition that must be completed at least every 90 days after the first time it is conducted. If it is not provided in a timely manner, the long-term care insurance company can stop paying benefits.
Why You Need a Long-Term Care Insurance Attorney
We can advise you on your rights under a long-term care insurance policy. Where appropriate, we can fight for your claim against any major insurance company nationwide. Please call our office to speak with an attorney and learn about your options. The call is free and there’s no obligation.