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HELPING PEOPLE LIKE YOU WITH THEIR DISABILITY, LIFE AND LONG-TERM CARE BENEFIT CLAIMS

Problems you could encounter with long-term care insurance

| Apr 23, 2019 | Disability Insurance Law Blog |

As you age, preparing for the future becomes a priority. Florida residents may be living longer, but they are also suffering from physical and mental ailments that require a substantial amount of care.

The odds of needing long-term care at some point in the future appear to be increasing each year. You may decide to prepare for this eventuality, including purchasing long-term care insurance, and you need to know what problems you could face with it.

Limitations on coverage and rising premiums

When purchasing this type of insurance, it’s vital to pay attention to the fine print. Does your coverage include a lifetime cap? If so, your benefits could run out just when you need them the most. By the time you need long-term care, the costs could increase significantly, and your coverage may not be enough. You could ask whether you can purchase an inflation rider, which may help keep your benefits closer to the costs you will face.

Another issue with these policies is that the premiums can rise dramatically at a time when your income may not increase to compensate for it. It’s not uncommon for premiums to increase as much as 200% once you reach the age of 70. This could make the policy cost prohibitive, and when you stop making payments, the coverage you depend on could disappear.

Benefits may not kick in soon enough

You would expect to begin receiving benefits within a reasonable amount of time after filing a claim, but with long-term care insurance, there is often a waiting period before that will happen. During this time, you must pay for your care on your own. You could have to wait anywhere from 90 days or longer before you begin receiving benefits. Again, looking at the fine print should tell you what you need to know.

You could experience a delay or denial of your claim

Insurance companies work for profit, which means that instead of paying out on them right away, they take their time attempting to find a way to either delay or deny your claim. One way in which companies do this is by making the claims process unnecessarily complex and time-consuming. Not only must you fill out the forms correctly, but you will also need to submit documentation to back up your claim.

The company may come back and say that you failed to provide all of the information needed, demand more “evidence” of your need or simply take its time in responding to you in order to delay paying on your claim. Some insurance companies will even insist that you undergo an assessment by one of their physicians. A doctor working for an insurance company knows where his or her paycheck comes from, which means some bias could exist. This could result in a denied claim.

You don’t have to deal with these issues alone

If you do experience issues with your long-term care insurance company, you may find it worthwhile to gain an understanding of your rights and a review of your policy to make sure you receive fair treatment. It may be possible to appeal the company’s decision, and if a review discovers that the company acted in bad faith, litigation may be in order. 

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