How insurers deny long-term care insurance claims

As more Baby Boomers continue to retire, long-term care insurance providers have to pay out claims for a large pool of customers. As a result, they may try to mitigate costs by not paying out all that is due.

There are several ways they may attempt this. They could deny coverage by claiming a long-term care facility is not covered in the plan, which may be true – plans written in the 1990s were written differently today. Regulation of the long-term care industry is more stringent now than it used to be, back when many of the current policy holders looking for payouts were purchasing plans.

The insurer may argue that the policy holder needs to have a previous hospitalization, nursing home stay or both before they will pay out the claim. This was often written into older plans. However, most states, including New York, have outlawed these provisions.

The insurance provider may refuse to pay benefits for “personal” care. Expenses such as light housekeeping, errands or care provided by family members are described as “personal” care. However, if the policy holder meets their policy’s activities of daily life (ADL) requirements, the insurance company should pay for the benefits.

There are many other ways insurers may avoid paying out the full benefits or denying your claim. It’s a stressful time to be fighting with an insurance provider, as the financial bills of long-term care can be overwhelming. Don’t allow an insurance company to push you around – you paid for the coverage and should be able to rely on it now when you need it most. If you believe you have been wrongfully denied long-term care insurance, please contact a San Diego long term disability lawyer or your area to review your options.