Skilled Long-Term Care Insurance Claims Attorneys in Naples, Florida
At Disability Insurance Law Group, our Naples long-term care (LTC) insurance claims lawyers have 50 combined years of experience representing policyholders in Florida and nationwide.
Our Collier County LTC attorneys know that when individuals and families pursue a claim for long-term care, it is because they require critical services associated with their difficulty performing daily activities independently due to aging, illness, disability, or cognitive impairment.
The reality is that more and more people need, or will need, long-term care services.
According to the U.S. Department of Health and Human Services:
- 70% of adults 65 years and older will eventually require long-term care.
- 48% of people turning 65 will need some paid long-term-care services in their lifetimes.
- 24% of people turning 65 will require paid long-term care for over two years.
- 15% of people turning 65 will spend more than two years in a nursing home.
According to World Population data, nearly 20,000 people live in Naples, and the median age of the residents is 66.3 years old. What’s more, the average cost of long-term care is over $100,000 per year, depending on the type of care needed.
This is what long-term care insurance is for. When our clients need assistance with activities of daily living (ADLs), long-term care insurance is designed to help them pay for the costs associated with long-term care services, typically not covered by health insurance or Medicare.
When insurers delay, undervalue, or deny long-term care benefits, individuals and families are in a challenging position that can impact their physical, emotional, and financial well-being.
We want to help.
If you and your family are counting on your long-term care insurance to pay for your medical and ongoing care needs and are now facing a coverage dispute or denial, contact our experienced insurance claims attorneys in Naples today for help.
Why is the Insurance Company Denying My Long-Term Care Claim?
Long-term care insurance is designed to provide coverage for a range of services and support needed when policyholders have a chronic illness, disability, or cognitive impairment that prevents them from performing basic activities of daily living without assistance.
That includes expenses associated with:
- Adult daycare supervision and interaction.
- Assisted living facilities.
- In-home care.
- Nursing home admission.
When individuals carry long-term care insurance, they often have these policies for decades because they know the coverage can mean the difference between receiving covered quality care and paying these enormous expenses out of pocket.
Common reasons insurers dispute or deny long-term insurance claims benefits include, but are not limited to:
Review your policy to check for any exclusions or limitations that may apply to your situation. Some policies exclude coverage for specific medical conditions or treatments.
Many long-term care insurance policies have a waiting period, also called the elimination period, before benefits are payable. If you are still within this waiting period, you may need to cover the care costs until it expires.
- Lack of Medical Necessity
Insurance companies typically require that the care you receive is medically necessary. If the insurer determines that the care is not medically necessary, they may deny the claim.
- Not Meeting Benefit Triggers
Long-term care insurance policies often have specific criteria, known as benefit triggers, that must be met to qualify for benefits. Common benefit triggers include needing help with activities of daily living or cognitive impairment. If you do not meet these triggers, your claim may be denied.
Insufficient or incomplete documentation of your condition or the care you are receiving can lead to a claim denial. Ensure you have a thorough and accurate medical condition and care services records.
Failing to file the claim within the insurer’s specified time frame can result in a denial. Review your policy for deadlines and adhere to them.
Some policies may restrict coverage to care provided by licensed professionals or specific types of facilities. Using non-covered providers or facilities may lead to a claim denial.
If your policy has a pre-existing condition waiting period, any conditions you had before purchasing the policy may not be covered during that waiting period.
If you allowed your policy to lapse due to non-payment of premiums, your coverage may have ended, and you may no longer be eligible for benefits.
Providing inaccurate or incomplete information on your application can result in a claim denial if the insurer determines that the misrepresentation influenced their decision to issue the policy.
- Change in Health After Policy Issuance
If your health deteriorates significantly after the policy is issued but before you file a claim, the insurer may investigate whether a material change in your health affects your eligibility for benefits.
Some policies have maximum benefit amounts or daily benefit limits. The excess expenses may not be covered if your care costs exceed these limits.
If your long-term care insurance claim is denied, taking action promptly is essential.
Our Naples long-term care insurance claims lawyers can help you understand your coverage’s terms, conditions, and exclusions so you can pursue the benefits you are entitled to.
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Contact Our Long-Term Insurance Claims Attorneys in Naples Today
Our extensive experience enables us to identify situations where insurers fail to meet their legal and contractual obligations. No matter where you live in the U.S., our attorneys are well-versed in the processes and procedures involved in pursuing a long-term care insurance claim and protecting our client’s rights under state and federal laws.
Contact our skilled long-term care insurance claims attorneys in Naples today by calling 954-989-9000 or contact us online to schedule a free and confidential case assessment so we can put our over 50 years of combined experience to work for you.