As part of your life planning, you bought long-term care insurance. You have paid exorbitant fees. When used properly, LTC insurance can give substantial financial support when you cannot care for yourself. However, all too often, when you need long-term care insurance benefits, the insurer is reluctant to pay them. To learn more about disability insurance companies, talk to an experienced attorney today.
Why are long-term care insurance claims denied by companies?
The greater part of long-term care insurance companies exists for profit. They are more concerned with their financial gain and shareholders than the best interests of seriously ill or disabled people who file claims.
Long-term care is extremely expensive compared to many insurance claims — a private room in a nursing facility or long-term care center can cost upwards of $83,000 annually. In other words, insurance firms and their adjusters are incentivized to carefully study these claims and hunt for grounds to deny them.
Why was your long-term care insurance claim rejected or delayed?
The most common concerns during a long-term care claim are mentioned below. However, remember that there are many reasons why your long-term care insurance claim may be denied. Meeting with an expert LTC lawyer to receive a specialized analysis and realistic next steps is advisable to thoroughly understand your case.
- Alleged failure to pay long-term care premiums
People occasionally skip or make late payments. In such cases, the insurance company may claim that your policy has expired and you are no longer entitled to benefits. Nonetheless, tight restrictions govern how insurance firms must act when a payment is missing. Even if they do not take these steps, you may still be qualified for long-term care benefits.
- Proper licensure of the facility
Suppose you or a loved one is in a nursing home or assisted living facility. In that case, the operator must verify to the long-term care insurance that it is an “eligible care provider.”
- No prior hospitalization
This is called “the gatekeeper provision, ” commonly included in old long-term care policies. This language demands that a policyholder be hospitalized, remain in a nursing facility, or both before claims are paid.
- No benefits for personal care
Some insurers may refuse to pay benefits for “personal” care, such as light housework or errands performed for the policyholder by a caretaker.
Long-term care claims rigorous demand examination and smart legal strategies. Instead of attempting to navigate your claim on your own, speak with an experienced attorney today.
