Mansell, Engel & Cole

Can your parent's long-term care insurance claim be denied?

Now that your parent has fallen considerably ill, either physically or mentally, you know that you will likely not have the ability to provide the needed care on your own. As a result, you have started looking into long-term care options to determine what services may best suit your loved one's situation.

Of course, as you explore these options, you may come to realize that you cannot afford the costs associated with such care. Before you panic, however, you remember that your parent has long-term care insurance. While you may feel thankful for this coverage, you need to remember that not every claim receives approval.

Look over the policy

Because the policy belongs to your parent and not you, it would benefit you greatly to go over the details of the policy. It may help you determine whether your parent presents any of the benefit triggers that could result in the policy coming into effect. Typically, these triggers include the inability to care for one's self in various ways, like losing the ability to get dressed, eat or bathe on one's own. If your parent suffers from a mental condition, such as dementia, it could also be a trigger.

You also need to understand what services and care providers the insurance policy covers. You may think you found the perfect nursing home or in-home service to care for your parent, but you may not have the ability to utilize it if the policy does not cover the specific service.

Making a claim

Going over every detail of the policy can help you determine whether your parent truly has a claim. By providing the needed information, making sure the policy covers the desired service and noting that benefits triggers are present, you may feel confident that the insurance provider will accept the claim. However, the insurance company will need to assess your claim, and you could still face a denial.

Addressing a denied claim

Receiving a denial letter from an insurance company can feel devastating and confusing. You may have believed that the information you submitted on behalf of your parent provided a perfect case for the insurance policy to kick in. Before you start doubting yourself, you may want to seek legal advice. Some insurance companies may unreasonably deny claims, and if this has happened to you, taking legal action may help you and your parent receive the needed coverage.

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