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How can I prevent surprise long-term care denials?

On Behalf of | May 23, 2022 | Denied Insurance Claims

Oklahomans who purchase long-term care insurance do so because they want to be able to pay for a nursing homestay.

It would be a major financial and emotional hardship if a person paid premium faithfully only to have their claim for long-term care benefits denied when they needed them.

Long-term care insurance carriers deny claims for a number of reasons.

  • They argue that the policy does not require them to pay.
  • They argue that the customer violated a term of the policy.
  • They argue that the insured provided false or misleading information when applying for coverage.
  • They assert other reasons for denying a claim.

Long-term care policyholders should review their policies, applications carefully

One of the most common reasons that long-term care insurance claims get denied is that the insurance company does not believe that its policy requires payment. A carrier may also rely on the policy to partially deny a claim or put a limit on how much the carrier will pay.

For example, the insurance company may argue that medical reports suggest the person applying for benefits could live independently or that the facility of a person’s choice does not qualify for coverage.

Sometimes, a carrier may argue that the policyholder has failed to cooperate with it or has violated another policy condition.

The bottom line is that Oklahomans need to understand their insurance policies and, specifically, know their rights and responsibilities.

On a related point, when applying for long-term care coverage, a person should make sure they understand their application and that they fill it out completely and accurately.

For example, if asked, a person should not try to hide their health problems. On the other hand, one need not volunteer information for which the insurance company does not ask.

Before paying benefits, an insurance company will likely review the application and may deny the claim if it feels that the application has misleading information on it.

Insurance carriers too often unfairly deny claims for long-term care

Unfortunately, many times, insurance carriers will deny or underpay claims for long-term benefits when they have no legal right to do so. In these situations, a policyholder may have legal remedies that they will want to explore.