How to Take Action When Your Long Term Care Claim Has Been Denied

Many long term care policyholders are finding that their claims are being denied. Insurance companies sold billions of dollars in long term care insurance in the mid- 1980’s and 1990’s to aging baby boomers that sought coverage should they need assistance in their twilight years.

Unfortunately, insurance underwriters had little experience underwriting these types of policies back then and underestimated the costs now associated with nursing homes, assisted living facilities and in-home care. As a result, many insurers are denying long term care claims and seeking to drastically increase premiums at the discretion of state insurance commissioners.

Who Can Really Help You?

Here are some ways you can receive help if your long term care policy has been denied:

Seek the advice of an attorney with experience in bad faith insurance claims. A qualified attorney can assist you when your long term insurer has wrongly denied your claim and when you’ve had enough and wish to take legal action. Unfortunately, many general practice attorneys don’t understand the nuances of how insurance companies operate, so make sure you find an attorney that specializes in bad faith litigation.

Complain to your state’s insurance commissioner. All states have an insurance commissioner who oversees the insurers licensed to practice in their state. A complaint may result in the state contacting the insurer on your behalf and may bring some results but it also recommend that you contact a long term care attorney.

Help yourself. The best way to help yourself is to be organized. Make sure you have your records in order and write down who you spoke with, when you spoke with them and what they told you. And when they don’t do what they said they would, contact them again.

There’s no reason for policyholders to accept the fact that their claim has been denied. If your long term insurance company isn’t responding to your long term care complaint – take action.

Case Studies: Taking Action When Your Long-Term Care Claim Has Been Denied

Case Study 1: John’s Struggle With Denied Long-Term Care Claim

John, a 72-year-old retiree, had purchased a long-term care insurance policy in the 1990s to ensure he would have coverage if he ever needed assisted living or nursing home care. However, when he finally filed a claim after being diagnosed with a chronic illness, his insurance company denied his claim. Feeling frustrated and helpless, John decided to take action.

John sought the advice of an attorney specializing in bad-faith insurance claims. The attorney thoroughly reviewed John’s policy and the denial letter from the insurance company. They discovered several discrepancies and inconsistencies in the insurer’s reasoning. With the attorney’s guidance, John initiated legal action against the insurance company, alleging bad faith practices.

Case Study 2: Sarah’s Pursuit of Assistance Through The Insurance Commissioner

Sarah, a 65-year-old policyholder, faced a similar situation when her long-term care claim was denied. Determined to seek justice, Sarah decided to file a complaint with her state’s insurance commissioner. She believed that the insurance company had acted unfairly and wrongly denied her claim.

The insurance commissioner’s office promptly reviewed Sarah’s complaint and contacted the insurer on her behalf. As a result, the insurer reassessed Sarah’s claim and ultimately reversed their decision. Sarah received the long-term care benefits she was entitled to, thanks to the intervention of the insurance commissioner.

Case Study 3: Lisa’s Persistence And Organization

Lisa, a 68-year-old policyholder, encountered significant challenges when her long-term care insurance company refused to respond to her complaints about denied benefits. Frustrated but determined, Lisa decided to take matters into her own hands.

She meticulously organized all her records, documenting every interaction with the insurance company. Lisa kept a detailed log of whom she spoke with, the dates of the conversations, and the information provided. When the insurance company failed to follow through on their promises, Lisa diligently followed up with them, holding them accountable for their actions.