Long-Term Care Insurance Law Done Right: Protecting Policyholders Nationwide

Long-term care insurance (LTCI) is designed to help policyholders cover the costs of essential daily care when they can no longer live independently. As these policies have grown in popularity, the demand for benefits has increased. Still, there is a gap between what policyholders believe is reasonable reimbursement and what insurers are willing to pay. At the same time, insurance companies have tightened their eligibility requirements, reduced the number of benefits offered, and raised the bar for the type of evidence needed to prove a claim.

These changes have led to a growing number of denied claims, leaving policyholders frustrated and financially vulnerable. We can help.

Why Proving Eligibility Can Be Difficult

Many long-term care insurance policies require proof of the inability to perform at least two Activities of Daily Living (ADLs) to qualify for benefits. ADLs often include basic functions such as eating, bathing, dressing, toileting, transferring, and maintaining continence. While these requirements may seem straightforward, proving the need for assistance is not always simple.

This is especially true when cognitive impairments, such as dementia or memory loss, prevent a policyholder from recognizing or accurately reporting their limitations.

Building a Strong Evidence-Based Claim

To meet the insurer’s requirements, policyholders must present thorough and credible evidence of their functional limitations. This can include functional capacity evaluations, neuropsychological testing, and in-home assessments conducted by licensed nurses or certified home care aides.

These evaluations can offer objective proof of the level of care needed, going beyond what might be documented in routine medical records. In addition, detailed notes and statements from healthcare providers and caregivers can strengthen the claim and address potential challenges from the insurance company.

The Role of Medical Professionals and the Need for Legal Guidance

It is important to remember that medical professionals are primarily focused on diagnosing and treating patients, not preparing documentation for insurance claims. As a result, their records may lack the level of detail insurers require to approve a claim.

This is where an experienced long-term care insurance attorney can make a significant difference. A lawyer who understands LTCI coverage can help gather the proper documentation, work with providers to ensure medical notes are complete, and anticipate the tactics insurers use to question or deny claims.

How Disability Insurance Law Group Can Help You Succeed

Representing clients nationwide, Disability Insurance Law Group has extensive experience helping policyholders navigate the complex claim presentation process. Our attorneys know what insurers look for, how to collect the evidence needed to satisfy strict policy requirements, and how to push back against unfair denials. We work closely with clients, their medical providers, and care teams to ensure all necessary supporting documentation is in place before the claim is presented.

Contact Disability Insurance Law Group at 954-989-9000 or online today. Our attorneys fight for policyholders across the United States to secure the long-term care benefits they have earned.