Representing People With Denied Insurance Claims

Why do insurance companies deny long-term care claims?

On Behalf of | Jun 3, 2020 | Denied Insurance Claims

When you or a loved one needs long-term care, you expect your insurance to help support that care. This is especially true for the 40% of the older population who are poor or near poor, older people who need the support from their insurance.

A denial from the insurance company can leave you with an uncertain future. How will you pay for necessary care? Could a small issue in your application be to blame? Is it possible to appeal this decision? Most of all, why was the claim denied?

Why are claims denied?

Insurance providers are required to properly investigate a claim before making the decision to accept or deny that claim. If they choose to deny a claim, they must also inform policyholders for the reason for that denial. Common reasons to deny long-term care insurance include:

  • Missed payments caused the policy to lapse
  • The insurance company does not believe that the policy covers the policyholder’s current condition
  • The policy does not cover the long-term care services used by the policyholder

This denial is not the end, however. If an insurance company denies your claim or the claim of a loved one, additional options may be available to you.

What can you do if the insurance company denies a claim?

If your claim was denied, you may also want to speak to an attorney about your denial. A lawyer with experience in long-term care insurance claims could help you carefully examine the reason for that denial of the claim and the details of the policy.

An attorney could help you determine whether the insurance company had valid reason to deny your application and challenge the denial. Collecting additional documentation to show evidence that the policy covers the care needed could help you support your case and get the additional support you need.