Long term care insurance is designed to help you cover the cost of long term care when you need it. People purchase long term care insurance to help with expenses such as home health care or staying at a nursing home. Unfortunately, even with insurance coverage, you may still experience claim denials.
When a long term care claim is denied, it can be frustrating, stressful, and overwhelming. Fortunately, an experienced attorney can help you or your family member obtain the benefits you deserve. In this article, we’ll discuss why long term care insurance claim denials happen and how an attorney can help.
How Do I Meet My Long Term Care Insurance Requirements?
Most long term care insurers require that a claimant needs assistance with their activities of daily living. A long term care insurance policy will specify what is considered an activity of daily living. In most policies, the activities of daily living are bathing, dressing, feeding, transferring, and toileting. It will also specify the number of activities a claimant must require help with to qualify for benefits.
An insured’s cognitive impairments may also meet the requirements to receive long term care benefits. If a claimant is a risk to themselves or others due to a cognitive impairment, they may be eligible for benefits.
Why Do Long Term Care Insurance Claim Denials Happen?
There are several reasons why long term care insurance companies deny claims. The most common reasons long term care benefits are denied include:
- Lack of coverage: The insurance policy may not cover the type of care or services you need.
- Failure to meet requirements for coverage: You may not meet the requirements for coverage. This could be due to a waiting period or pre-existing condition exclusion.
- Administrative errors: Mistakes can occur during the application or claims process, resulting in a claim denial.
- Insufficient documentation: You may not have provided sufficient documentation to support your claim.
- Disputed medical necessity: The insurer may dispute the medical necessity of the care or services you received.
How Can an Attorney Help?
If your long term care insurance claim has been denied, an attorney who specializes in disability insurance law can help. A disability insurance lawyer can assist you in the following ways:
- Reviewing your policy: A lawyer can review your policy to determine if there was a valid reason to deny your claim.
- Appealing a denied claim: An attorney can help you appeal by gathering additional evidence and representing you during the appeal process.
- Filing a lawsuit: If necessary, an attorney can file a lawsuit against the insurance carrier.
- Negotiating a settlement: In some cases, an attorney can negotiate a settlement with the insurer outside of court.
Dealing with a long term care insurance claim denial can be a daunting task. However, by seeking legal advice from an experienced insurance attorney, you can increase your chances of getting the benefits you deserve. An attorney can review your policy, help you appeal the denial, and represent you in court if necessary.
Do not let a claim denial stop you from getting the long term care that you need. Contact an attorney who can help you fight for your rights. Although based in Florida, the Ortiz Law Firm represents claimants across the United States. Call us at (888) 321-8131 to schedule a free case evaluation with a Long Term Care Insurance attorney.