Common Reasons Long-Term Care Claims Are Denied Nationwide

Long-term care (LTC) insurance policies are designed to provide financial support when you can no longer manage essential daily tasks on your own. Unfortunately, many policyholders are surprised to learn that qualifying for benefits is not straightforward.

Denials often result from strict policy requirements, unclear definitions, and procedural traps that insurers use to delay or avoid payment. Knowing the most common reasons for denial can help you avoid costly mistakes and protect your rights under your policy.

How the Elimination Period Can Delay or Prevent Benefits

One of the most misunderstood aspects of long-term care policies is the elimination period. This is the amount of time you must pay for care out of pocket before your benefits begin. The length of this period varies by policy, typically ranging from 0 to 180 days.

While it might sound simple, the elimination period is a trap for the unwary. Many policyholders present a claim before hiring the services they need, only to discover that the elimination period does not even start to run until those services are in place.

This can create a frustrating cycle. The insurer may begin requesting additional documentation and dragging out the process, but without services in place, the clock never starts. In some cases, policyholders wait months before hiring an aide or beginning qualifying care, effectively extending the elimination period indefinitely. The key is to understand exactly what triggers the elimination period in your policy so you can start it as soon as possible.

When Hospital and Rehabilitation Stays Do Not Count

Another common source of confusion involves whether hospital or rehabilitation stays count toward the elimination period. In some policies, they do not count at all, meaning that only the time you receive qualifying care at home or in an approved facility will move the clock forward.

In other policies, the rules are even more restrictive. For example, some require that a home healthcare aide be physically present for a certain number of days each week. Under some policies, having an aide just one day in a week allows the entire week to count toward the elimination period, while others require daily care to qualify.

Because these details vary from policy to policy, it is vital to review your contract carefully and seek legal advice if you are unsure. Misunderstanding these provisions can delay the start of your benefits and give insurers more time to find other reasons to deny your claim.

How Disability Insurance Law Group Protects Policyholders Nationwide

Disability Insurance Law Group assists clients across the United States in navigating the complex and often confusing rules in their long-term care policies. Our attorneys know how insurers use elimination period provisions and other technical requirements to delay or deny payment. We work with you to ensure you have the necessary care arrangements in place, present your claim correctly, and challenge any improper denial.

Taking the Right Steps From the Start

If your claim has been denied or delayed because of elimination period rules or other technicalities, you do not have to handle it alone. Acting quickly to meet your policy’s requirements can make a significant difference in when your benefits begin and whether your claim is approved.

Contact Disability Insurance Law Group at 954-989-9000 or online today. Our attorneys help policyholders nationwide get the benefits they deserve.