Long-term care insurance is designed to help you pay for long-term care if you need it. People buy long-term care insurance to help with expenses such as home health care or a stay in a nursing home. But when a long-term care claim is denied, it can be frustrating, stressful, and overwhelming. An experienced attorney at the Ortiz Law Firm can help you or your family member get the benefits you deserve. In this article, we’ll discuss why long-term care insurance claim denials happen and how we can help.
Why Do Long-Term Care Insurance Claims Get Denied?
There are several reasons why long-term care insurance companies deny claims. The most common reasons for long-term care insurance claim denials include the following:
- Lack of Coverage: The insurance policy may not cover the type of care or services you need.
- Failure to Meet Eligibility Requirements: You may not meet the eligibility requirements. This could be due to a waiting period or pre-existing condition exclusion.
- Administrative Errors: Errors may occur during the application or claims process, resulting in a claim denial.
- Insufficient Documentation: You may not have provided enough documentation to support your claim.
- Disputed Medical Necessity: The insurer may dispute the medical necessity of the care or services you received.
How Do I Meet the Eligibility Requirements?
Most long-term care insurance policies require that an applicant need 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 need assistance with to qualify for benefits.
A person’s cognitive impairment may also qualify them for long-term care benefits. If a claimant is a danger to themselves or others due to a cognitive impairment, they may qualify for benefits.
How Can an Attorney Help with My Claim Denial?
If your long-term care insurance claim has been denied, an attorney who specializes in disability insurance law can help. For example, a disability insurance attorney at the Ortiz Law Firm can assist you by:
- Reviewing Your Policy: We can review your policy to determine if there was a valid reason for denying your claim.
- Appealing a Denied Claim: We can help you appeal by gathering additional evidence and representing you during the appeal process.
- Filing a Lawsuit: If necessary, we can file a lawsuit against the insurance company.
Your Next Steps
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 keep you from getting the long-term care that you need. Contact an attorney like Nick Ortiz who can help you fight for your rights. Although based in Florida, the Ortiz Law Firm represents claimants throughout the United States. Call us at (888) 321-8131 to schedule a free case evaluation with a long-term care insurance attorney.
