Long Term Care Insurance Lawyer

A common reason for LTC insurance claim denials is the insurance application process. When applying, you must answer health-related questions, helping the insurer decide if they should issue the policy. When a claim is filed, the insurance company reviews these application answers. Any inconsistencies or inaccuracies may be grounds for denial. The denial typically suggests that had they received accurate answers during the application; they might have yet to issue the policy.

Here's an example of how such a denial may occur:

Imagine a 55-year-old man buying LTC insurance. The application includes a question about specific medical conditions. He answers "no" because, at the time, he hadn't been diagnosed with these conditions. However, a few years before buying the policy, he saw a neurologist due to symptoms resembling Multiple Sclerosis, though no diagnosis was made then.

After the policy was issued, his symptoms resurfaced, leading to an MS diagnosis requiring assistance with daily activities. The LTC insurance claim was denied based on the prior medical consultation, even though no diagnosis was made.
In cases like this, challenging the denial may be possible, mainly if it hinges on interpreting prior medical records. Legal action could help recover some or all of the owed funds.

When buying long term care insurance, ensure you provide accurate answers to any questions about your prior health to ensure that you won’t experience a claim denial when a long term care claim has to be made. If your claim is denied, contact our team of long term care insurance lawyers to see how we can help you.

A 77-year-old woman is suffering from several health conditions. Her ADLs were impacted, and to qualify for payments under her LTC policy, two of the following ADLs would require assistance:

• Bathing

• Dressing

• Eating

• Mobility

• Transferring

• Toileting

• Continence

• Cognitive Impairment

She did require some help with mobility and had cognitive impairment. Her family believed the LTC policy should cover her and submitted a claim. However, the claim was denied on the grounds that while she faced mobility and transferring issues, she could handle them some of the time. Additionally, although she had cognitive challenges, the insurance company didn't consider them severe enough to render her unable to care for herself.

She could still manage the remaining ADLs. Whether she qualified was debatable, but there was enough ambiguity to warrant further examination.

Through legal action, her family managed to recover funds from the insurance company on a compromised basis, providing the assistance she needed.

If the insurance provider claims that your loved one passed away for a reason excluded in the insurance policy, contact our team of long term care insurance lawyers to see how we can help you.