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The importance of additional documentation after a denied claim

On Behalf of | Dec 4, 2020 | Denied Insurance Claims

Many will need additional care in their later years, which has led many to purchase long-term care policies to manage the cost of that care. However, many of these same people may find that the insurer they rely on denies their claim when they most need support.

When insurers deny a claim, insurance providers must include the reason for that denial. The most common reason for claim denial is that the provider does not believe that the policyholder’s condition is severe enough to merit long-term care. In many of these instances, appealing the provider’s decision depends on gathering additional documents that support their need for care.

What documents may be beneficial in an appeal?

While the initial long-term insurance claim likely included medical records, an insurance provider may believe that those records do not show that the condition is severe enough to merit care. Supporting documentation can highlight the necessity of long-term care. In addition to test results and nursing assessments, it may also help to have a physician’s statement that details the person’s difficulties.

Additional documentation can be vital for those who have dementia or other conditions that often involve a slow decline. Documentation can show the changes in their condition over time, including their current challenges and past condition.

Consider speaking to an attorney.

If your long-term care insurance provider denied your claim, you do not have to face the appeals process alone. An attorney can help you examine the terms of your policy, collect documentation that supports your claim and guide you through the process of appealing the insurance company’s decision. They can also help you take legal action if your insurance company denied your claim in bad faith.