Representing People With Denied Insurance Claims

Take these steps to protect your long-term care insurance claim

On Behalf of | Oct 5, 2021 | Denied Insurance Claims

The need for long-term care is astounding. In fact, some studies show that about 70% of elderly individuals will need some sort of long-term care at some point in their lives. This care can take many shapes, mind you, including nursing home care, home health aide services, and assisted living services.

As stressful as that may sound, even more nerve-wracking is the costs associated with long-term care. In 2020, those without long-term care insurance faced as much as $105,000 per year in long-term costs. Nursing home care is by far the most expensive of the long-term care options, but even home health aides can exceed $50,000 a year and so, too, can homemaker services.

While those figures might be stunning, you may not be as daunted by them if you have long-term care insurance. However, if you or a loved one has one of these policies, then you need to be aware that many claims filed under them are denied for a variety of reasons.

Preparing your long-term care insurance claim

Fortunately, there are steps that you can take to better position your long-term care claim for success. Let’s look at some of them:

  • Review the policy’s language: We know that insurance claim policies are littered with boring and confusing language, but those words are critically important to your ability to recover compensation for long-term care costs. For example, your claim may be denied if you or a loved one is obtaining services from a provider that isn’t identified as an “eligible care provider” under your policy. Your policy will also specify the waiting period that must pass before benefits can be paid out. Make sure that you or your loved one is abiding by the policy when seeking benefits.
  • Document physical challenges: Before a claim will be paid out, you’re going to have to demonstrate that you or your loved one can no longer perform activities of daily living. These activities include bathing, feeding, clothing, and grooming oneself. Going to the bathroom by oneself is also included in this list of activities. Oftentimes, insurance companies argue that the claimant is still capable of performing these duties, albeit with some struggles, so he or she does not qualify for coverage under the policy in question. You can fight back against this assertion if you have documentary evidence to the contrary.
  • Obtain favorable medical opinions: Before paying out a claim, an insurance company may request that you or your loved one be evaluated by a doctor of its choosing. These doctors oftentimes downplay the severity of cognitive limitations, Alzheimer’s, and dementia, meaning that they end up supporting claim denial. You can push back against those opinions, though, if you have strong medical evidence of your own. So, talk to your doctor and make sure that you have adequate testing conducted to show the true extent of your or your loved one’s limitations.

Take a thorough approach to your long-term care claim

Keep in mind that these are just a few of the many steps that you can take to protect your long-term care claim. Going up against aggressive insurance companies can be daunting for sure, but you don’t have to be scared to stand up and fight for what’s right. Instead, you can diligently work to understand the intricacies of your claim and the tactics that insurance companies use to deny claims. Then, you can competently gather the evidence you need to build compelling legal arguments and support your claim. If that sounds like a lot, don’t worry. Help is just a phone call away.