Nationwide Long-Term Care Insurance Claim Attorneys

At Disability Insurance Law Group, our Fort Lauderdale long-term care insurance claims lawyers represent individuals in Florida and nationwide who face resistance through disputes or denials from their insurance providers.

Our Broward County insurance claims attorneys know that individuals and families purposefully seek long-term care insurance policies to help ensure they will not have to pay for costly future care needs that health insurance does not cover out of their pockets.

No matter where they live or work in the U.S. or if they are retired, most long-term care policyholders would never imagine their insurance provider disputing or denying their claims. Unfortunately, it happens all the time, and it is impacting some of the country’s most vulnerable residents.

According to a study from the Urban Institute and the U.S. Department of Health and Human Services, about 70% of Americans who reach age 65 will need some long-term care during their remaining years. For those who do not have family members who can provide free, part- or full-time help, nearly half will need some paid assistance. What is more, approximately 24% will need more than two years of paid care, and around 15% will spend two-plus years in a nursing home. These expenses can be astronomical and devastate any savings you are counting on going forward.

If you and your family were counting on your long-term care insurance to pay for your medical and ongoing care needs and were met with a letter of dispute or denial instead, contact our skilled insurance claims attorneys today for help. Our law firm represents insured clients across the country and works tirelessly to ensure their provider pays for the coverage they were counting on from their long-term care insurance policies.

Why Do People Need Long-Term Care Insurance?

Long-term care insurance is intended to provide essential care when an injury or medical condition interferes with a person’s ability to care for him or herself independently.

To qualify for long-term care benefits, individuals typically must be unable to care for themselves independently. Many policies insist that they cannot perform at least two out of six essential activities of daily living (ADLs).

These activities include:

• Bathing and grooming.
• Dressing.
• Feeding.
• Continence.
• Toileting.
• Mobility.

Long-term care insurance covers costs not usually covered by traditional health insurance or Medicare, and long-term care expenses average $56,000 per year, which is not a feasible expense for most people.

Benefits available under a long-term care insurance policy can include:

• Help with daily activities in your home.
• Assisted living care.
• Adult daycare and other community programs.
• Nursing home care.
• Visits by nurses or other home healthcare professionals.
• Medical devices.
• Transportation.

For those who are hoping Medicare will pick up where their health insurance leaves off, they are often surprised to learn it only covers short nursing home stays or limited amounts of home healthcare.

If you do not have insurance to cover long-term care, these expenses must be paid out of pocket, which can devastate your savings while leaving you with extremely limited care options.

The best time to pursue long-term care insurance is while you are healthy and planning for the future. If you wait until you are suffering from a debilitating disease, it will be too late to secure a policy. Talk to your family and insurance provider about potential coverage options so you are ready for anything that may come your way — even if it doesn’t.

What are the Top Reasons Insurance Companies Deny Long-Term Care Claims

Insurance companies may deny long-term care claims for various reasons.

While each policy and claim situation is unique, here are some common reasons for claim denials:

• Policy Non-Compliance: Policyholders must adhere to the terms and conditions outlined in their long-term care insurance policy. Failure to pay premiums, providing false information on the application, or not meeting the eligibility criteria can result in a claim denial.
• Waiting Period: Many long-term care insurance policies have a waiting period, also known as an elimination period, during which the insured must pay for their care before the insurance coverage begins. If a claim is made before the waiting period is satisfied, the claim may be denied.
• Lack of Medical Necessity: Insurance companies typically require that the care provided is medically necessary. If the insurer determines that the care is not medically necessary or that the insured can perform daily activities without assistance, they may deny the claim.
• Excluded Services: Some policies may have specific exclusions for particular care or services. If the care sought falls into one of these excluded categories, the claim may be denied.
• Insufficient Documentation: Proper documentation and medical records are essential for long-term care claims. If the necessary documentation is not provided or does not support the claim, it may be denied.
• Pre-Existing Conditions: Long-term care insurance policies may have pre-existing condition exclusions. If the insured requires care related to a pre-existing condition within a certain waiting period, the claim may be denied.
• Waiting Period Reset: If a policy has a waiting period, making a claim and then canceling or changing the policy could reset the waiting period, requiring the insured to satisfy it again before coverage begins.
• Unapproved Care Provider: Some policies specify that an approved or licensed provider must provide care. If an unapproved provider provides the care, the claim may be denied.
• Policy Limits: Long-term care policies have maximum benefit amounts or limits on the duration of care. If the claim exceeds these limits, it may be denied once the maximum benefits have been exhausted.
• Change in Health Status: If the insured’s health condition improves to the point where they no longer meet the eligibility criteria for long-term care, the claim may be denied.
• Misrepresentation: Providing inaccurate or incomplete information when applying for the policy can lead to a claim denial if the insurance company discovers the misrepresentation.
• To avoid claim denials, it is crucial to understand your long-term care insurance policy thoroughly, keep up with premium payments, maintain proper documentation, and work with your healthcare providers to ensure the care provided aligns with the policy’s requirements.

If your claim is denied and you believe it was wrongfully denied, you can often appeal the decision by seeking experienced legal advice from our nationwide long-term care insurance claims attorneys to resolve the issue.

What To Do When Insurers Fail To Cover Long-Term Care Expenses

Insurance company attorneys draft many long-term care insurance policies and contain provisions specifically designed to limit the responsibility of the insurer or to make it more difficult for policyholders to obtain coverage and compensation. It is, therefore, essential that policyholders’ rights are protected against bad-faith insurance practices designed to make it more difficult for individuals to receive the long-term care benefits they are due. We can help.

Contact our nationwide long-term care insurance attorneys today to ensure your rights are protected from the start of your claim so you can get the coverage you are entitled to from your policy.

Disability Insurance Law Group Is Here To Protect Your Long-Term Care Benefits

Disability Insurance Law Group can effectively protect your rights for the duration of your claim. Our experienced and accomplished insurance lawyers have advocated clients’ rights against unfair treatment by major long-term care insurance companies.

Our extensive experience enables us to rapidly identify situations in which insurers are failing to live up to their legal and contractual obligations. Our attorneys are well-versed in the specific processes and procedures involved in pursuing a claim and protecting our clients’ rights under state and federal law. We work tirelessly to help policyholders obtain the total limits of long-term care coverage to which they are entitled. We can also answer your questions about long-term care insurance.

Contact our skilled long-term care insurance claims attorneys in Florida today by calling 954-989-9000 or contact us online to schedule a completely free and confidential case assessment so we can put our over 50 years of combined experience to work for you.

We also offer the services for:

• Accidental death dismemberment insurance
• Appealing disability insurance claim denial
• Eating disorder claims
• Life insurance claims
• Disability Insurance Claims