Fighting A Long-Term Care Insurance Claim Denial (And How To Win)

The Secret Behind Why Your Long-Term Insurance Claim May Have Been Denied

In the 1980s and 1990s, insurance companies sold billions of dollars of long-term care (long-term care) insurance policies to baby boomers. Unfortunately for the policyholders, the underwriters greatly underestimated the real costs associated with assisted living facilities, nursing home care and in-home care expenses.

Consequently, insurance companies have become more prone to deny even valid long-term care claims. The companies have realized that they are facing losses in the hundreds of millions paying out long-term care benefits on underfunded policies. So, at this point, long-term care insurance companies are trying to staunch their losses, at your expense.

But, the demand for long-term care benefits continues to grow coincident with the growing ranks of aging baby boomers. It’s no surprise then, that insurance companies are making it harder for you to receive the long-term care benefits that you legally and rightfully deserve.

So, what do you do if your insurance company has denied your claim?


Strategies To Fight The Denial

In order to fight and insurance company’s decision to deny your long-term care claim, the first thing you need to do is to understand why your claim was denied. Partnering early with an experienced denied long-term care insurance claim lawyer is the best approach to accomplishing this goal. Insurance companies are specifically required by law to state why a claim was denied. However, sometimes the explanations they offer are difficult to understand. This can be especially true when you are fighting just to get through the day. It’s, therefore, essential that you receive the insurance company’s reasoning for their denial decision in writing.

The second step is to start getting your records in order so that you have documented proof to fight your denied long-term insurance care denial case.


How to Organize Your Medical Records to Fight a Long-Term Insurance Claim Denial

  1. Make sure you have all updated medical records ready for the insurance company review. This should include any objective testing, such as MRIs, X-Rays, CT Scans.
  2. Get a letter from your physician, and all licensed healthcare professionals involved in your care, to affirmatively state that you, or your loved one, needs assistance with activities of daily living (ADLs).
  3. There are six activities of daily living that come under the qualifications of proof of long term care insurance benefits. You typically need only qualify for two to satisfy them.
  4. Keep a daily journal of your challenges with your ADLs. Note down what happened, where it happened, and when. A video or audio record of your challenges can be hard to refute. We highly recommend this approach.
  5. Write a brief statement as to why you now need assistance with your activities of daily living.h Explain what changed. An experienced long-term care insurance claim denial lawyer can be very valuable with this step, as attorneys know what types of information and statements the insurance companies will find credible.
  6. You can also include a brief statement from close family members about how your life has changed and you can no longer do the things you once did. All the better if these people, such as a spouse or child, now help you with your ADLs.
  7. Provide information about any assistance you are currently receiving. For instance, if you pay for care out of your own pocket, include the invoices, and a statement from the person providing the care describing what duties they perform for you.


When to Call an Attorney – The Earlier, The Better.

Insurance companies will not hesitate to use your lack of knowledge of the complex, byzantine rules and policies involving long-term care claims. In fact, insurers will use that inexperience against you. Never forget that you are dealing with highly trained and skillful professionals who have no personal investment in your day-to-day health challenges. One missed deadline, for example, can stop payment of your claim in its tracks.

That’s why having an experienced attorney fighting for you significantly improves your chances of success. Your attorney will know how to develop a persuasive appeal letter and know what kind of medical evidence you need to submit to support your claim. An experienced attorney will also be familiar with the doctors and specialists who can potentially help with your case. Lastly, your attorney will know whether to immediately appeal to an insurance company, or file a lawsuit.


Call Donahue & Horrow

At Donahue & Horrow you will receive compassionate and highly skilled legal representation from highly experienced long-term care insurance lawyers. We know how hard it can be for a family and their loved ones to face the reality of suddenly needing day-to-day at-home assistance. Facing the daily – and hourly – challenges of long-term care can be emotionally and financially devastating. We believe that a denial is unacceptable when a person has faithfully paid for their long-term care insurance benefits. Those benefits are deserved. When you reach out to us, we know that your dignity and respect are on the line. We will fight tenaciously to make sure you get what you deserve.


Know all your options – call today: 877-664-5407