Long Term Care Disability Insurance
You’ve made the investment in long term care insurance for yourself or a loved one. You’ve chosen a policy that will provide the benefits you expect to need for nursing home or other long term care. You should be covered. But, it doesn’t always work out that way. The claims process and the documentation required varies depending on the insurance company and the specific policy, and you may not know where to start.
Worse, you may do everything asked of you and still encounter problems in securing your benefits. After all, the insurance company isn’t in business to help you–they’re in business to make money. Unfortunately, that means some set up unnecessary obstacles or even deny claims in bad faith. Understanding the process, where to get information, and what to do if your claim is denied is the first step toward protecting your rights.
Long Term Care Disability Claims
Who Qualifies for LTC Disability Benefits?
Generally, health screening is required to purchase a long term care disability insurance policy. But, that doesn’t mean the policyholder has to be in perfect health. The exact requirements will vary depending on the policy and the underwriter.
Eligibility to claim benefits typically depends on inability to perform at least two of the following six activities, known as “activities of daily living” (ADL). They are:
- Bathing
- Dressing
- Transferring (the ability to walk or to transfer to and from a wheelchair)
- Toileting
- Eating
- Continence (control of bladder and bowels)
However, the specifics may differ from policy to policy. For example, under some policies, inability to perform these activities independently includes needing someone on hand to assist–typically described as “standby assistance.” But, under others, the covered person must actually be unable to perform the tasks. It’s important to pay attention to these seemingly-small differences when choosing a policy, and to check the policy terms before initiating a claim.
How Does the Claims Process Work?
Since long term care coverage is private insurance offered by different companies, the claims process will differ somewhat based on your policy. As soon as you recognize that the time to file a claim is approaching, review the policy to find out what is required.
Common requirements include:
- Completion of a form or statement that includes information about the claimant’s medical history, the activities he or she needs support to perform, and whether the need is expected to be temporary or permanent.
- Verification from the claimant’s doctor, including details about the type of care required and why. Depending on the circumstances, test results or other medical records may be required.
- A care plan based on the claimant’s specific condition and needs.
- If the claimant is already receiving long term care services, a variety of information may be required from the provider(s).
The insurance carrier will typically also require that the claimant sign a medical release form authorizing the company to receive medical records and other information from healthcare and long term care providers.
What Happens if My Claim is Delayed or Denied?
When you purchase an insurance policy, you want to believe that the company will hold up its end of the bargain. In other words, you should be able to expect that the insurer will promptly process your claims, make decisions in good faith, and provide benefits in a timely manner. Unfortunately, that doesn’t always happen.
The good news is that your insurance policy is a contract. That means you have enforceable rights.
How Can a Lawyer Help after You’ve Been Denied LTC Benefits?
If your LTC insurance carrier denies your claim, you likely have appeal rights under your policy. But, many people aren’t aware of their rights or don’t understand the process for appealing, and so miss the deadline or don’t put together a strong appeal. An attorney experienced in fighting insurance company denials will be familiar with your legal rights and able to quickly locate the critical information in your policy.
An attorney who handles LTCI denial claims will also know what type of information is most effective in overcoming denials, and how to use the legal process to enforce your rights. That’s true even if you haven’t received a formal denial and the company has failed or refused to process your claim within a reasonable time.
Get Help with Your Long Term Care Disability Claim Today
If you’ve been wrongly denied long term care benefits, your best first step is to educate yourself about your rights and options. Your window to appeal a decision may be limited, so it’s important to act quickly. To schedule a free consultation right now, complete the lead form below and a representative will contact you shortly.
