A Delray Beach insurance lawyer understands that many senior citizens had the foresight to purchase home healthcare or long term care insurance to cover the cost of the care they need to assist them with the activities of daily living. Unfortunately, Medicare does not cover these costs, unless the senior citizen is indigent. Even then, the benefits available are limited.
Home healthcare or long-term care insurance policies pay for the expenses that Medicare doesn’t cover. An Delray Beach insurance lawyer knows the benefits available vary from policy to policy, but at a minimum, most policies provide coverage for home healthcare if the insured needs assistance with at least 3 activities of daily living, such as bathing, dressing, toileting or eating, or if the insured has a cognitive impairment, such as Alzheimer’s disease or dementia. Driving, cooking and cleaning are generally not considered to be activities of daily living, and thus a need for assistance with any of these does not trigger the insurer’s obligation to pay benefits under a home heath care or long-term care policy.
Issues often arise regarding the need for care or the amount of benefits available under the policy. Many home healthcare or long term care insurance policies have a “restoration of benefits” clause that allow the insured to claim the full amount of benefits available under the policy even if most of the benefit limit has previously been paid, if the insured has gone without the need for care for 6 months. The question of whether the insured has needed care during this period of time is often challenged by the insurers, and this can be negated by your Delray Beach insurance lawyer. Often times, medical records or testimony from a treating physician is necessary to support a claim that an individual needs assistance with the recognized activities of daily living, or that the individual did not need care for 6 months or longer.
If an insurer denies coverage to an insured, or fails to honor a claim in full, Florida law allows the insured to recover attorney’s fees if a lawsuit is successfully brought against the insurer. Thus, even if the amount in dispute is rather modest, a lawyer who is successful in helping an insured can recover their fee from the insurer for the time spent assisting the insured.
Insurance disputes, like insurance policies, can be complicated and difficult for most people to understand. An experienced insurance lawyer can help you determine whether you have a valid claim. Please feel free to call me to discuss your case. The initial consultation is free, and you will speak directly with me, Eric Luckman, a Delray Beach insurance lawyer about your home healthcare or long term care insurance and your rights.
Eric Luckman is a Florida Board Certified Civil Trial lawyer. Less than 10% of lawyers in the state of Florida are recognized with this prestigious certification. Board certification recognizes attorneys’ special knowledge, skills and proficiency in various areas of law and professionalism and ethics in practice.
Feel free to call our office to discuss your case. The initial consultation is free, and you will speak directly with Eric Luckman, about your claim and your rights.
An experienced Delray Beach insurance lawyer can help you determine whether you have a valid claim.