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Long-Term Care Insurance Company Tactics Archives

DI Law Group Successfully resolves Long Term Care Claim against Genworth

DI Law Group was hired to assist a 91 year old woman in obtaining the home health care benefits to which she was entitled under her long term care policy with Genworth Insurance Company. After months and months of providing Genworth with information, medical records, and physician forms clearly detailing her inability to safely dress, transfer, and bathe without either hands-on or standby assistance, she and her son became extremely frustrated and reached out to our firm. Our client, a widow who I will refer to as Mrs. X, procured a long term care and home health care policy over 25 years ago and timely paid her premiums every year because she felt it was important not to have to burden her children physically and financially should the day come that she could no longer take care of herself. About 2 years ago, Mrs. X began to experience some memory issues, balance problems, and overall weakness. However, she took great pride in being extremely independent and was extremely reluctant to admit that she needed assistance. As a result, her son (who is in his 60s) became very worried and felt it necessary to spend more time with her to make sure that she did not fall and could get to her doctor appointments. Unfortunately, her health continued to decline and after her 3rd or 4th fall he convinced him mom to apply for home health care benefits under her Genworth Long Term Care plan.


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.


Many purchase long term care insurance for peace of mind. That is the selling point of these often pricey policies and the promise made to insureds by their long term insurance carrier. Unfortunately, when an individual has gotten to the point where they struggle to take care of themselves and are forced to admit they need the benefits promised under their long term care policy, the long term care insurance company makes the process complicated, lengthy, and frustrating. The carrier's financial incentive to "slow walk" and/or deny a claim is quite strong given that the benefit under many policies may exceed $1,000.00 per week. However, there are steps that an insured and their family can take to make sure the process goes as smoothly as possible.

Long Term Care and Home Health Care Policy Issues

It appears that many companies that sold long term care and home health care insurance had little idea of what a claim would involve or that at some point they would be responsible for the payment of so many claims. Over the last several years, many companies have attempted to avoid the payment of benefits by either misinterpreting, narrowly interpreting, or simply ignoring policy terms and/or benefit options.

The Importance of Designating Someone to Receive Secondary Notice Under Your Long-Term Care Insurance Policy

Designating someone to receive secondary notice under your (or your loved one's) long-term care insurance policy could mean the difference between losing a valuable insurance benefit or keeping it in force. Some long-term care insurance policies and even some state statutes allow an insured the right to designate a third party to receive a copy of certain notices also sent to the insured. The importance of having such a proper designation on file with the insurance company cannot be understated.

Denial Tactics Used By Insurance Companies to Deny Your Long-Term Care Insurance Claim

Long-Term Care Insurance covers costs involved with personal or medical services that are needed for an individual who is unable to care for him or herself due to disability, chronic illness, loss of functional capacity, or cognitive impairment. Thus, the goal and reason for paying costly Long-Term Care Insurance premiums is to cover the expensive services involved in keeping a loved one as independent as possible in these situations.

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