Long Term Care Insurance Claims and Appeals

Long-term care (LTC) insurance can be a good way to protect your assets and your family from the high costs of care associated with getting older.  But like with other types of insurance, carriers tend to deny the claim first and ask questions later.  This can lead to an unexpected outlay of funds, not to mention incredible stress at an already difficult time.  It is prudent to seek the services of an experienced attorney to prepare the initial claim for long-term care benefits to avoid this scenario and is critical in the face of a denial and appeal.

Long-term care policies are designed to cover or defray the cost of home care, assisted living, nursing home care and other care needs when an individual requires assistance with activities of daily living, such as bathing, dressing, grooming, eating, using the bathroom, and assistance with mobility.

The concept of long-term care insurance is much like any insurance: the beneficiary files a claim to receive benefits under the policy when there is a qualifying event.  However, the reality of getting a claim paid is often quite frustrating, as LTC insurers frequently engage in delay tactics or deny otherwise valid claims for reasons ranging from self-serving interpretation of policy language to reliance upon biased doctors or nurses to justify the denial. 

Whether through delay or outright denial, LTC insurers often bank on a claimant’s frustration.  Unfortunately, many claimants do give up, allowing the LTC insurance carrier to collect years and years of premiums without paying out for rightful and legitimate claims.  

GDGC’s decades of experience dealing with insurance carriers, interpretation of medical records, claims and litigation can help guide you through this often complex and daunting process.  Many wrongful denials may be overturned without resort to litigation.  A carefully and properly prepared claim or appeal by GDGC’s experienced attorneys is a claimant’s best way to ensure receipt of benefits.