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Alzheimer’s and denied long-term care insurance claims

On Behalf of | Feb 8, 2021 | Denied Insurance Claims

Alzheimer’s disease, the most common form of dementia, seems to be increasing in commonality. In fact, some statistics show that more than five million Americans live with the disease, which can wreak havoc on the brain’s ability to function, thereby impacting memory, cognitive ability, and daily living. Since the disease primarily affects those age 65 and older, many Baby Boomers who took out long-term care insurance are now wondering how best to utilize their policies, while others are struggling to figure out what to do with a denied claim.

Long-term care claim requirements

Before your or your loved one’s insurance company will grant a long-term care claim, they’re going to want to see proof that functional and/or cognitive capacity has been lost. That may seem easy enough to assess, but this is where a lot of conflict with insurance companies comes from.

When it comes to functional capacity, the insurance company is going to look at a number of activities to see how many the claimant is incapable of performing. Amongst these activities are dress, going to the bathroom, bathing, getting in and out of a bed or a chair, eating, and getting dressed. An inability in multiple areas should qualify the claimant for long-term care services.

The insurance company may also assess if the claimant has suffered severe cognitive impairment. What does that mean? Well, it really depends on the language used in the insurance policy. However, it usually includes some sort of deterioration of intellectual capacity and an inability to protect one’s self without the assistance of another individual. Proving poor cognitive functioning will probably take medical evidence, such as those that address the claimant’s memory; his or her orientation to time, place, and person; and his or her ability to reason.

Caregiver challenges

Those who take care of a loved one with Alzheimer’s can face a lot of physical and emotional challenges, but what we’re referring to here is how the role of caregiver can be defined and thereby affect a long-term care insurance claim. In many policies, there’s a waiting period between when the insurance company deems a claimant eligible for care and when it will actually start paying for services.

A 60-day waiting period, for example, might not sound all that bad, but it can when you delve into the fine print of the policy. Sometimes the waiting period is only counted when the claimant receives care from someone deemed qualified by the insurance company or the policy. This might mean that an individual could provide in-home care for their loved one who is suffering from Alzheimer’s only to find out months later that none of the waiting period has passed, or their claim has simply been outright denied.

What this means for you?

That might all sound scary, but we share this information not with the intention of alarming you, but of informing you so that you can take the steps that are necessary to protect yourself or your loved one. If you’re having trouble with an insurance company, then you want to make sure that you have the evidence needed to support your claim and a sound legal basis for making your claim.

You also don’t want to let insurance companies take advantage of you or your loved one simply because insurance policies and the claims process are confusing. That’s why experienced law firms like ours help people like you or your loved one stand up for what is right. We know the underhanded tactics that insurance companies use to try to tighten claims payouts, and we aggressively fight back against them. So, if you’d like to learn more about what you can do to try to right the wrong of your or your loved one’s insurance company, then now may be the time to speak with an experienced law firm with a track record of success.