Why Was My Long Term Care Insurance Claim Denied?

As many as 70% of all Americans age 65 and older will find themselves needing long term care at some point. The average stay in a skilled nursing home is about three years, while others are able to remain at home but need home care, which averages about five years for most people.

Paying for long term care is a big worry for seniors and their families, as the cost can easily consume retirement nest eggs.

Owning a Long Term Care insurance policy is better than not having a LTC policy, but unfortunately coverage isn’t always as promised.

A recent article from Newsday, Senior Safety Net, shares the challenges faced by individuals and families whose coverage was denied, even after decades of paying premiums. An elderly person who is so ill they require nursing home care is the least likely person to be able to navigate the pitfalls of applying for coverage and fight back when the long-term care insurance company wrongly denies their claim.

Why Do Long Term Care Insurance Companies Deny Claims?

There are many similarities between long-term care insurance and long-term disability insurance denials and our firm has represented many people whose LTC coverage has been wrongfully denied. For the insurance companies, it’s a matter of profits, but for the elderly people who paid premiums in good faith for the protection they needed in their later years, it can be an unexpected financial disaster.

Even when all the policyowner does all the right things, their claim can be wrongfully denied. Sometimes the families try to write their own appeal letter or enlist the help of the treating physician to provide additional information. When families are not able to resolve these matters, they turn to attorneys like us for help.

What Can You Do to Prepare for a Long Term Care Insurance Claim?

Policyowners should let a designated person know they have a long term care policy and where the paperwork can be found. This person will need to be able to gain access to the file and, if necessary, enter the home if the insured is in the hospital.

The designated person will need to have the name of the company, the policy number and contact information for the person who sold the policy. The insurance agent should be enlisted to help if there is a problem.

It may be necessary to contact a long term care insurance attorney if the insurance company does not respond to policyowner or family representative queries. It’s not what was expected when the policy was purchased, but fighting back to get the benefits already paid for is a better choice than giving up and losing a lifetime of savings.