The need for long-term care in our country is astounding. Some estimates put the rate at 60%, with 40% of elderly individuals needing some sort of nursing home or assisted living care. That’s why decades ago long-term care policies were extremely popular. These policies seemed like a good investment. After all, long-term care can be enormously expensive. But now that Baby Boomers are getting older and cashing in on those policies, insurance companies are struggling to find a way to avoid the astronomical costs associated with paying out a long-term care claim.
Legitimate reasons why long-term care claims are denied
There are a lot of reasons why long-term care insurance claims are denied. Although a claim denial can be frustrating, not all of them are wrong or illegal. In fact, these policies are so intricate that many policyholders violate the terms of their policy without even realizing it.
For example, a long-term care policy might have very specific qualifications that a long-term care provider must meet in order for the insurance company to consider them eligible for claim payments. If the provider that you select doesn’t meet those qualifications, then your claim may be denied, even if you’ve paid all of your premiums in a timely fashion. Other legitimate reasons for denial include inadequate medical documentation proving limitations to your daily living, you received only short-term care, or you don’t have a proper plan of care in accordance with your policy’s requirements.
Don’t accept your insurance company’s explanation upfront
Even if your insurance company is basing its denial on one of these legitimate reasons, you shouldn’t simply accept what the insurance company is telling you as true. These policies are enormously detailed, and insurance companies try to stretch each policy’s language in order to try to wiggle free from having to pay out a large claim.
Therefore, you’ll want to consider appealing your long-term care insurance claim denial. To prepare for that appeal, you should be as prepared as possible. You should know your insurance policy down to every detail and gather documentation that speaks to every aspect of the policy. This means obtaining relevant medical records, especially those that speak to the need for long-term care. You should also keep track of all communications with the insurance company so that they can’t backtrack on what they’ve told you. Acquiring the assistance of a skilled legal advocate might be in your best interests, too.
Appealing your denied claim
Failing to appeal a denied long-term care insurance policy claim can cost you thousands, perhaps even tens of thousands, of dollars in out-of-pocket costs. In other words, if you’re like most Americans, you can’t afford to allow your claim to be denied. So, be prepared to fight back during the appeals process. Adhere to the appeals process’s requirements and meet all deadlines. Know the law and how to use it to your advantage. And don’t give up until you know you’ve exhausted every legal avenue available to you.
That may sound daunting, but you don’t have to face these challenges alone. Skilled legal advocates like those at our law firm stand ready to help you better understand your insurance policy, why your insurance company has acted the way it has, and what you can realistically do about it. Only then can you work with your advocate to develop a legal strategy that best positions you to find accountability and recover the benefits you deserve.