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How can your long-term insurance claim be denied?

On Behalf of | May 29, 2023 | Insurance Disputes

Long-term care can be extraordinarily expensive, sometimes costing well over $100,000 a year. Without proper savings and protection, then, a stay in a long-term care facility can devastate your finances, leaving you with little if anything to pass on to your loved ones when the times comes.

That can be a stressful thought, but you might feel a sense of relief if you have a long-term care insurance policy that you’ve been diligently paying premiums on. However, despite the promises that these policies seem to make, many claims filed by policyholders end up denied, leaving them in a dire financial predicament.

If you want to avoid that from happening to you, then you need to know some of the common reasons why these claims are denied so that you can try to get out ahead of them and increase your chances of recovering the benefits that you deserve.

Top reasons why long-term care insurance claims are denied

The insurance company has a lot of justifications that it can rely upon to deny your claim. Here are some of the most common:

  • Insufficient evidence: Before an insurance company will agree to pay your claim, they’re going to want evidence that shows that you meet eligibility requirements. This means that you’ll need to submit adequate medical documentation that demonstrates your need for long-term care. There may be other policy provisions that you need to speak to, as well, so make sure that you review your policy to gain an understanding of what, exactly, you’ll need to show in order to be granted the benefits that you need.
  • Missed premiums: In order for your insurance policy to be valid, you have to have made all of your premium payments and kept your policy active. All too often, though, a medical condition or family emergency causes you to miss a payment, which could jeopardize your claim. That said, there are certain guidelines that an insurance company must follow before allowing your coverage to lapse. You’ll want to familiarize yourself with those requirements so that you can challenge your denied claim if warranted to do so.
  • Lack of covered services: “Long-term care” sounds all-encompassing, but your long-term care insurance policy likely is not. In fact, there may be key services that are not included in your policy. There may be other services that are covered but only if certain conditions are met. In the latter circumstances, you’ll want to make sure that you’re armed with evidence to show that you meet all conditions identified by your policy.
  • You can still perform daily living activities: In order to succeed on your long-term care insurance claim, you’re going to have to demonstrate that you can’t engage in some of the most essential daily living activities. These include bathing, grooming, dressing, and feeding oneself, as well as going to the bathroom by yourself and moving. If you have limitations in several of these areas, then you should be in a strong position to succeed on your claim. But be prepared for the insurance company to challenge you there.

Don’t take your insurance company at their word

Your insurance company is going to sound like it has strong justifications for denying your claim. But you shouldn’t just accept what they’re telling you at face value. Instead, you should dig deeper to see if you can figure out if any errors were made in assessing your claim or if you can argue back against your insurance company to secure the outcome that you deserve.