What Happens When Your Long-Term Care Claim is Denied?

According to The American Association for Long-Term Care Insurance, in 2012, more than 8 million Americans have long-term care insurance. People over 80 years old made up more than one-half of the claims opened in 2012.
What does long-term care insurance cover?
Generally speaking, long-term care insurance is designed to cover expenses not covered by Medicare. Minimum coverage generally allows in-home care if the insured is unable to take care of themselves in their own home. However, before a claim may be approved, the insured must meet some minimum requirements such as:
• Dementia or Alzheimer’s disease – if the insured person is diagnosed with Alzheimer’s or dementia generally they are eligible to collect for in-home care that is not covered by Medicare
• Self-care limitations – if an insured is incapable of meeting three or more of their own daily needs including cooking, hygienic needs or dressing themselves, they may be eligible for in-home care
It is important to bear in mind that each policy is different and your policy should be reviewed by someone who understands the policy and the limitations.
Florida law and denied insurance claims
What happens when you put a claim in for long-term care at home or in a skilled facility and your insurance company rejects your claim? This is when you need help from an experienced insurance attorney who will fight to protect your interests. Since insurance is meant to help defray the expenses of skilled care, going without care because an insurance company denied a claim can be a health hazard. Florida laws allow insured persons to file a suit if they believe their claim was wrongly denied. Additionally, if the claimant wins their case, the insurance company must also pay the cost of legal fees associated with getting benefits paid.
Before filing a claim

Before you file a claim for long-term care coverage, it is important review your policy carefully. Keep in mind, each policy has different clauses and may have exclusions that apply to your individual case. Additionally, if you do not file for coverage immediately upon needing assistance, you may have difficulty getting the insurance company to pay your claim. Some things to keep in mind:

• Long-term care does not just apply to nursing homes – in most cases, long-term care policies are designed to cover both in-home and nursing care in an assisted living facility or nursing home.
• Delaying filing a claim could hurt you later – if you do not file a claim when you initially need skilled care, your insurer may use this as a reason to not pay your claim. The theory being if you needed the care you would have filed sooner.
• Deductibles and terms – your policy should be carefully reviewed so you understand what deductibles and exclusions apply and how long your coverage will last.
If you have any problems with an insurer denying your claim for long-term coverage, contact the Law Office of The Law Office of Eric H. Luckman, P.A. Our offices have experience fighting denied insurance claims for residents in West Palm Beach, Florida. We’ll help you get the benefits you are entitled to based on your policy coverage.
Sources: http://www.aaltci.org/long-term-care-insurance/learning-center/fast-facts.php