Legal Help When Insurers Fail to Pay You the Benefits You Are Owed
Navigating the long-term care insurance claim process can be complicated and frustrating, and many times insurance companies will unfairly delay or deny the payment of your benefits. This can be financially and emotionally devastating for both you and your family.
Our attorneys understand that your financial and medical independence is at stake when you must file a long-term care insurance claim. Your need for long-term care and the steep costs for this type of care do not go away if your insurance company denies your claim. Although a person who is dealing with a prolonged illness or serious injury is facing one of the most difficult times in their life, the insurance company is trained to have no empathy. Our attorneys at Disability Insurance Law Group have 25 years’ combined experience in handling insurance matters. We guide our clients through the entire process and aggressively fight to assert our clients’ rights at every stage. Our attorneys can prevent most insurance claim denials through effective preparation of your insurance benefit application. We are also very successful in having claim denials overturned. And, if the insurance company refuses to overturn a wrongful denial, our attorneys will not hesitate to aggressively assert our clients’ rights at trial or even in appellate courts when necessary.
Filing a Claim for Long-Term Care Benefits Under Your Policy
Your long-term care policy governs your claim for benefits. Thus, it is crucial that you obtain a complete copy of your long-term care policy and understand what your insurance contract requires prior to filing a claim for benefits.
It is important to be aware that long-term care policies require that you provide the insurance company with notice and proof of claim within strict time periods. It is your responsibility as the claimant to provide adequate proof of your entitlement to insurance benefits within the required time periods. Your failure to do so will likely result in a denial of your claim. Thus, it is necessary that you act quickly when your need for long-term care benefits arises.
Your application for benefits can be one of the most important documents in filing your insurance claim. It can help or haunt you throughout the entire claim. The applications are written by insurance companies to benefit insurance companies. While it may look like a simple form, it is often created to illicit certain information and to discourage a full description of your situation. An application for benefits should never be taken lightly. Insurance companies often misconstrue and take information contained on these forms out of context to deny claims. Our long-term care insurance attorneys have the experience necessary to recognize problems before they begin. We guide our clients through the process and thoroughly review all documents before they are submitted to the insurance company.
Common Delay and Denial Tactics Utilized By Insurers
Common claim delay or denial tactics utilized by insurance companies include the following:
Slow walking: The practice of insurance companies delaying payment of insurance benefits by simply continuing to request additional, duplicative and seemingly unnecessary information. The insurance company will assert that without this additional information, it is unable to approve your claim for benefits.
Cancellation of your policy due to nonpayment of premiums: There are requirements under your policy and the law that require the insurance company to allow you a certain period of time to become current with premium payments. The insurance company may also have been required to provide a “third-party designee” notice of nonpayment of premiums before it was allowed to cancel the policy. However, many insurance companies ignore or neglect to comply with these requirements.
Misconstruing a limitation under your policy and/or the facts of your claim: Common denial tactics used by insurance companies in long-term care claims include them arguing one or more of the following to deny your claim:
- You weren’t hospitalized prior to needing long-term care
- You do not suffer from an acute medical condition
- The long-term care services that were provided to you were not provided by a properly qualified professional or service provider as defined under your policy
- The long-term care services provided for you are available under Medicare or another governmental program
- The long-term care services that were provided to you are not covered under your policy
- You are not unable to perform your “activities of daily living”
- The care or services that you received are unrelated or unnecessary for you to carry out instrumental activities of daily living or unrelated to your needs because of a cognitive impairment
- You did not need the level of care that you were provided
- The insurance company’s doctor says that you do not qualify for long-term care benefits even though your doctor is stating that you do
- You have not provided sufficient ongoing verification of long-term care needs
- You suffer from a pre-existing condition
- Your medical condition is not covered because it is the result of one of the following: mental illness, attempted suicide or intentionally inflicted injury, alcoholism or drug addiction, war or acts of war
We Have Years of Experience Successfully Pursuing Long-Term Care Insurance Claims
Let our experienced attorneys assist you in dealing with your insurance company. We can anticipate the unfair and deceptive tactics employed by insurance companies to delay or deny the payment of your long-term care benefits. The attorneys at Disability Insurance Law Group are dedicated to evening the playing field for our clients. We use our experience in handling complex insurance benefit matters to guide our clients through the process and vigorously fight to protect our clients’ rights. We handle long-term care insurance claims with large and small insurance carriers including: Aetna, American Republic, Bankers Life and Casualty, Berkshire Life, Conseco, Continental Casualty Company (CCC), Genworth (GE), John Hancock, Knights of Columbus, MassMutual, MedAmerica, MetLife, Mutual of Omaha, Northwestern, New York Life, Penn Treaty American, Prudential Financial, State Farm, Unum and others.
Contact Us Today for a Free, Confidential Assessment
If you have questions regarding long-term care insurance, contact Disability Insurance Law Group. We are a nationwide firm offering free initial consultations. Call us toll free at (954)-989-9000 or email us to speak with one of our attorneys, or to schedule an appointment. Let us deal with them for you.