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Why are long-term care insurance claims denied?

Nursing home care, assisted living care, home care and other types of long-term care can all carry high costs. One thing some individuals do to try to reduce the financial impact future long-term care needs would have on them and their family is to get a long-term care policy.

Unfortunately, some individuals end up encountering an unpleasant surprise when they make a claim under such a policy. Sometimes, insurers deny such claims.

Such denials can occur for various reasons. Some examples of grounds an insurer might claim when denying a policy are that:

  • The policy lapsed due to missed payments.
  • That the policyholder’s current condition doesn’t yet rise to the level of qualifying them for covered care.
  • That the long-term care services the policyholder is receiving are not among the services that the policy covers.

There are things individuals can do to try to reduce the chances of receiving a claim denial. One is to carefully look at the terms of the policy before making long-term care decisions, such as picking a long-term care provider, to understand what the policy does and does not cover. Another is gathering documentation on one’s current medical condition to provide evidence that one would qualify for covered care.

An important thing to remember is that just because an insurer denied a claim doesn’t mean they had valid grounds to do so. Sometimes, in their efforts to save money, insurers end up issuing unfair denials. So, when a long-term care claim is denied, it can be important to look into whether the insurer had grounds for the denial and whether there would be a strong basis to challenge the denial. Skilled insurance law attorneys can do this for individuals and families who have received long-term care insurance claim denials.

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