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Stand Up after LTC Claim Denials

January 12, 2015

What Long Term Care Insurance Covers

If you are reading this article, you likely already know that long-term care insurance is not like health insurance. Long-term-care insurance helps pay for the assistance if you become ill or disabled at some point.  It is designed to cover long-term services, including personal and custodial care, in your home or other assistive-living facility.  These policies reimburse policyholders a daily amount (up to a pre-selected limit) for services to assist them with activities of daily living such as bathing, dressing, or eating.

Standing Up to Insurers after LTC Claim Denials

After Long Term Care claim denial, here’s what you can do to stand up to your insurance company. Don’t hesitate to contact Denver Attorney Shawn McDermott for experienced help with your case.

After Long Term Care claim denial, here’s what you can do to stand up to your insurance company. Don’t hesitate to contact Denver Attorney Shawn McDermott for experienced help with your case.

When you’ve purchased long-term care (LTC) insurance protection, you want to be able to trust that your insurance company that took your premium payments for years will honor your policy and will be there for you when you need it.  Often times, its children or another loved one who bought the coverage, and now they need the benefits promised them, but the insurer refuses to honor its contractual commitment.  The reality is that:

  • Insurers don’t always act in policyholders’ best interests;
  • Insurers can make mistakes; and/or
  • Insurers can simply make bad (possibly even illegal) decisions regarding policyholders’ LTC claims.

 

When this happens, it’s crucial for policyholders to realize that:

  • Standing up to insurers can be essential to obtaining benefits.
  • Appealing LTC insurers’ decisions with the help of a lawyer can be vital to the success of these claims

After an LTC Claim Denial: How to Stand up to an Insurer
After insurers deny valid LTC claims, here’s what policyholders can generally do to fight back and get the benefits they need and likely deserve:

  1. Get a copy of your policy — If you do not already have a copy, request it from the insurer. If your LTC coverage was provided by your employer, contact the human resources department and request a copy of the policy or summary plan description.
  1. Hire an experienced attorney – LTC insurance policies, as well as the laws and codes that apply to them, can be complicated. Understanding the details of policies (and the applicable laws) is generally necessary to effectively fight LTC denials. So, the best, first step people can take after an LTC claim denial is retaining an experienced attorney to pursue the internal appeal process or file a lawsuit if necessary.   There are traps for the unwary that an experienced attorney can help you avoid.
  2. Demand the insurer honor the valid LTC claim – Once you have a lawyer representing you, the next step to take is generally making a demand to the LTC insurer to honor the existing policy and your claim. One option may be to submit a detailed explanation letter (or internal review request) to the insurer with your position and evidence in support of your valid claim.  Depending on the law that applies to the claim (e.g. ERISA), an appeal may be a required step.  There can be a number of effective ways of proving the validity of a policyholders’ claim.  This may include pointing out the unclear aspects or provisions of the LTC policy or proving that the policyholder should be covered under the terms of their LTC policy (e.g. why the claim is “medically necessary.”)
  3. File legal action against the insurer – When demands to honor LTC claims are unsuccessful, the next step can be to take legal action against the insurer.  Filing a lawsuit is usually an action of last resort but may be necessary to prove entitlement to the benefits provided under the LTC policy of insurance and to fight back against a continuing unreasonable delay in the claim process.

LTC Claim Denials: The Importance of Choosing the Right Lawyer

Given that the success of fighting insurers after LTC claim denials can hinge on your choice in an attorney, be sure that you make the right choice in the lawyer you retain to handle your case. Just a few of the things to look for when selecting the right lawyer to oversee your claim include an attorney who:

  • Works on contingency – Contingency means that an attorney will not require an upfront fee for his services and that legal fees will only be charged in the event that you obtain compensation in your case. Finding a lawyer who works on contingency to handle your case can be essential to not compounding your financial stress as you fight for your rights to LTC benefits.
  • Has experience dealing with various LTC insurers – Because different insurers have different types of policies and procedures/strategies for managing related claims, it’s also best to retain a lawyer with experience dealing with various LTC insurers, some of the more popular of which include (but are by no means limited to):
  • Unum
  • Prudential Insurance
  • CNA Insurance
  • Genworth
  • Transamerica Life Insurance
  • Mutual of Omaha
  • Conseco
  • John Hancock.

 

Denver LTC Insurance Attorney Shawn E. McDermott both works on contingency and has extensive experience dealing with insurance companies.

Denver, Colorado LTC Insurance Lawyers at McDermott Law, LLC

Has your long-term care claim been denied by an insurer? If so, you can turn to Denver LTC Insurance Attorney Shawn E. McDermott for experienced help standing up to insurers and appealing your claim denial. Dedicated and experienced, Shawn McDermott has a record of success when it comes to helping people fight denied insurance claims, navigate the complexities of the legal system, stand up to insurers and ultimately obtain the benefits they need and deserve.

To learn more about how the long-term care denial and long term disability attorneys at McDermott Law, LLCcan help you, set up a complimentary consult with our office today by calling us at (303) 964-1800 or by emailing us using the contact form on this screen.

From our offices in Denver, we provide the highest quality legal services to disabled  people throughout the state of Colorado, the surrounding states and nationwide.

Categories: Blogs, Disability, LTC Insurance

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