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Long Term Care Insurance Denial Lawyer
Individuals who require long-term care are generally not sick in the traditional sense, but instead, are unable to perform the basic activities of daily living (ADLs). ADLs include such thing as dressing, bathing, eating and toileting. Nursing homes, in-home care providers, daycare facilities and family members often help seniors perform these activities. These are the kinds of services that long-term care insurance (LTCI) is meant to cover.
LTCI is designed to provide or cover the costs of providing ADLs. ADLs include dressing, bathing, eating, toileting, continence, transferring (getting in and out of a bed or chair), and walking. LTCI alleviates the burden and responsibilities often picked up by family and community members. Many individuals and families purchase LTCI to supplement or relieve a spouse, children and family members from having to provide this type of care.
Without LTCI, the cost of providing these services can quickly deplete the savings of the individual who needs the services or their family. When a LTCI claim is denied or limited by the insurance company, family members and loved ones don’t get the paid for benefits. Worse, they often must focus on other things that the LTCI policy would have covered.
How Long Term Care Insurance Denial & Dispute Attorneys Can Help You
Between 1980 and the early 2000s the LTCI industry as a whole made poor assumptions concerning policy costs and payouts. Insurance companies found that their policies pay out much more than they took in, making many of these policies unprofitable. As a result, many insurance companies have a strong monetary incentive to minimize, deny and delay claims.
Thousands of families and policyholders are having difficulties getting claims paid. In your time of need, the last thing you want is a fight with an insurance company. The covered policyholder is usually in a debilitated state and does not have the energy or mental faculties to fight the insurance company. A spouse may be in a similar state or be overburdened by caring for their debilitated spouse. Children of policyholders often lack insurance expertise or are otherwise unable to help.
Insurance company contracts are often complicated and difficult to read and interpret. And insurance companies won’t hesitate to interpret vague or ambiguous language in their favor. Insurance companies may refuse or delay claims over a variety of complicated issues including: facility or caregiver licensing; claims the policyholder is not sufficiently impaired to need care, or that the policyholder has not complied with policy terms. We can help you or your elderly family member fight insurance denials. Since 1999, we have been in the business of fighting for people and families to get the maximum benefits from their insurance policies. If you need legal representation in a denied or disputed long-term care insurance claim, contact our office. We want to help. Scott Glovsky is recognized as one California’s most experienced, compassionate, and trusted insurance law attorneys. Complete the form on the right of this page for a free consultation.
Benefits of Long Term Care
LTCI policies vary widely and cover a variety of services and time periods. They may include in-home care if appropriate, assisted living facility care and nursing home care. Policies may have no caps or be capped at a maximum benefit. LTCI policies generally include coverage for one or more of the following: in-home care, assisted living, adult daycare, respite care, hospice care, nursing home care and Alzheimer’s facility care.
One of the more popular benefits is coverage for in-home care. Instead of family members helping with ADLs, shopping, groceries and appointments, caregiver’s provide these services. Policies may cover a limited number of hours each week or provide seven days a week, 24 hours a day benefits.
LTCI generally does not cover costs covered by health insurance, Medicare, or Medicaid. Families and individuals purchase LTCI so that they or their loved ones can have the daily care they need if they become incapacitated and cannot take care of themselves.
Long Term Care Benefit Eligibility and Deductible Issues
Policyholders qualify for benefits when they need help with activities of daily living or when they are impacted by a severe cognitive impairment. Policies often utilize a type of deductible called an elimination or waiting period. During the waiting period, the policyholder pays for care. These periods can be as long as a year.
