Long-Term Care Insurance: Getting People the Benefits They Deserve

LTC Insurance Industry News

Recent consideration of the CLASS Act legislation, which would have permitted workers to buy long-term care (LTC) insurance regardless of their health, put LTC insurance into the minds of many Americans. Often, people are reluctant to purchase LTC insurance because of the cost of coverage and their fears that their claims will be denied, in addition to uncertainty as to whether they will actually need the benefits in the future.

For people with LTC insurance who believe their claims are being unfairly denied, however, a long-term care insurance claims attorney can help them fight for the benefits they deserve.

Long-Term Care Insurance

LTC insurance provides cash benefits to policy holders for a variety of services that help them perform their activities of daily life. Depending on the terms of the policy and the needs of the individual, LTC insurance may provide coverage for assistance by a family member, other unskilled worker or skilled care provider with things ranging from supervision of daily tasks to complete assistance in accomplishing basic needs such as bathing, dressing and eating.

According to California Health Advocates, an independent non-profit organization that provides support, information and advocacy on behalf of California’s Medicare beneficiaries, LTC insurance benefits may cover services provided at home, in a community setting, in assisted-living facilities and in nursing homes. Most often the desire of the policy holder and his or her caretakers is to provide long-term care services to help the individual stay out of a nursing home and live as independently as possible.

Long-Term Care Statistics

A recent survey of California residents found that people are increasingly aware of the high cost of nursing-home and long-term care in their older years, yet few indicated that they are willing to purchase LTC insurance. According to a study performed by the California Partnership for Long-Term Care, a California Department of Health Care Services program, people are twice as likely now to report awareness that typical health-insurance plans do not provide coverage for long-term care than did 17 years ago.

In addition, 52 percent of the 950 adults surveyed said they believe that more than half of America’s older population will need long-term care in their lifetimes, reports the Wall Street Journal. This is a significant increase from the 42 percent who reported the same belief in the same survey performed in 2005.

In fact, the U.S. Department of Health and Human Services reports that 70 percent of older Americans need some level of long-term care at some point in their lives. And, considering that the California Partnership for Long-Term Care states that the average annual cost of nursing-home care in California is more than $91,000, buying LTC insurance may be a smart decision for those who can afford it.

However, the Wall Street Journal reports that only about 10 to 18 percent of Americans over age 65 have LTC insurance coverage. The California survey found that people have several reasons for not purchasing LTC insurance, including:

  • LTC insurance costs too much: 59 percent of survey respondents;
  • Have not thought about LTC insurance: 55 percent
  • Have sufficient funds and assets cover long-term care expenses: 32 percent
  • Insurance companies cannot be trusted to provide benefits: 29 percent

These telling statistics reveal the depth of people’s concerns over the need for long-term care as well as their mistrust of insurance companies offering LTC insurance benefits. Their concerns are not unfounded.

Unfair LTC Claim Denials

In testimony for the House Energy and Commerce Committee in Congress, a representative from California Health Advocates recounted several experiences of California residents who felt cheated by their LTC insurance companies. One woman’s claim for benefits was denied because the assisted-living facility in which she resided had six beds, and her LTC insurance company said it would only provide coverage for facilities with 10 beds or more.

Another person’s insurance claim was denied because the LTC insurance company said it could not tell whether the applicant wife or her husband needed long-term care, even though the wife had just had knee surgery. In other cases, LTC insurance companies have refused to pay benefits until the policy holder is in a nursing home, which is precisely the outcome some people buy LTC insurance to avoid.

California LTC insurance claim lawyers have heard myriad similar stories, and they have helped many people in their quests to obtain benefits, sometimes under policies for which they have been paying premiums for years – even decades. If your claim for LTC insurance benefits has been denied, or if you would like more information about LTC insurance, contact an attorney with experience in long-term care cases.


If You, or a Loved Ones’ Long-Term Care Insurance Claim Was Wrongfully Denied. Contact Our Law Firm Today to Schedule for Your Free Case Evaluation

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