Long Term Care/Home Health Care Insurance providers seem to make a habit of doing everything possible to delay making a decision on a long term or home health care claim for benefits in what would appear to be a clear effort to avoid paying benefits owed under these very important, and often lifesaving policies. Like many of our clients, Mrs. X procured an insurance policy that would pay for a health care aid in her home if and when she needed assistance with at least two of the Activities of Daily Living. At age 91, she had balance issues and was weak; and thus it became dangerous for her to bathe without hands on assistance, get dressed without hands on assistance, and get in and out of chairs, her bed, or a car without either hands on or standby assistance. Despite what would appear to be her clear right to benefits under her policy, her long term care insurance company, John Hancock, continued to request information from Mrs. X and her physicians, claiming they did not have sufficient information upon which to make a decision. Because Mrs. X could not function without assistance from an aide and had little family in the area that could help her, she was forced to pay the home healthcare aid from her own limited finances, thereby making it extremely difficult for her to meet her monthly financial obligations.
After 3 months of waiting, despite providing the carrier with sufficient proof that she is entitled to benefits under her policy, Mrs. X retained DI Law Group to handle her claim and get her the benefits to which she was entitled under her long term care policy. Our attorney’s contacted the company requesting a detailed status of the claim and provided the claims representative with the proof already submitted as well as additional detail further proving Mrs. X’s right to benefits. We also advised that one of our attorneys will be present during the in home evaluation scheduled for the following week. The home evaluation went smoothly as Mrs. X’s home health care aide was also present and able to discuss her clinical observations and Mrs. X’s significant limitations. We submitted a demand immediately following the evaluation and benefits were approved and paid 48 hours later.
If you or a loved one are experiencing unfair claim delays, had a claim denial, or are thinking about applying for long term care benefits please feel free to contact our firm for a free consultation. We would be happy to discuss the terms of your policy and ways in which the claim for benefits can be approved. We handle claims throughout the nation. Our toll free number is (866) 363-3628 or you can contact us through our website at www.dilawgroup.com