Mansell, Engel & Cole

When long-term care brings long-term headaches

If you are the kind of person who likes to cover every base and leave nothing to chance, you likely make lists, keep a calendar and make frugal decisions with your money. Chances are, you have made ultimate plans, like choosing a power of attorney and writing a will.

When you took out your long-term health care policy, you probably felt good about your decision. Knowing that people are living longer lives, but facing the possibility of a prolonged illness or incapacitating condition, you purchased an insurance policy and faithfully paid the outrageously high premiums. Now, just when you need it, the insurance company has denied your claim.

Long-term care options

Like many who make the sacrifice to purchase an LTC insurance policy, you likely investigated your many options. While it is impossible to predict the kind of care you might need in the future or the kind of services your physical condition may require, you may have researched to get a general idea of the medical conditions that run in your family and the average life expectancy of past generations. With this information, you examined the options available in many LTC policies, including:

  • In-home care
  • Adaptations to your home
  • Adult day care
  • Assisted living
  • Nursing home care

Your policy may also promise other services in addition to these. Possibly, your policy placed a limit on the benefits available to you in years or dollars, and this choice may have greatly affected the amount of your premiums.

What's it for if I can't use it?

Often the first sign that you may need to claim your LTC benefits is when you cannot bathe yourself. Insurance policies refer to this as a benefit trigger since it triggers your qualification for receiving your LTC benefits. However, if such a trigger occurred within the policy's waiting period, you may have had to cover some expenses on your own until your benefits kicked in. If, even after you have met all the eligibility requirements for care, your insurance company denied your claim, you may be worried about what the future holds for you.

Seeking the assistance of an attorney is your right when an insurance company unfairly denies a claim for which you deserve benefits. An Oklahoma attorney can review your policy thoroughly, and zealously advocate for your rights before an unscrupulous insurance company.

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