It appears that many, if not most people underestimated the amount and/or cost of long-term care related expenses when settling for premiums and coverage for the long-term care products their respective companies offered. Now, after policyholders have paid significant premiums over a substantial period of time in many instances, insurers are no providing the care, benefits and/or services to which they are obligated under the insurance contract.
With the aging of the baby-boom generation, the reduction of coverage associated with many other forms of benefits or insurance, and the increasing cost of healthcare, many insurance companies are finding that they are losing money on long-term care insurance policies. To compensate, sometimes they are improperly denying claims. Other times, they are unlawfully delaying responses and/or not providing coverage when the insured needs it most. In other situations the breach of the contract is more innocuous. Florida law requires certain steps to be taken by the insurance company to help prevent this unfair and unjust action.
We can help ensure that the law has been complied with. We may often get benefits that have been improperly denied and, in some occasions, benefits that you or your loved one were outright cheated out of.
If your claim for long-term care has been denied, unreasonably delayed, or if you have not been given the proper amounts or services to which you are entitled, you may need the assistance of long-term care attorneys.
Long term care insurance policies should provide you with extended care for a variety of medical conditions and issues, but your claim may be denied if the insurance company thinks it can avoid the cost of providing you the care you deserve, need and are entitled to. Sometimes insurers will have a so-called “expert” that they hire and pay to review your records and declare that you do not meet the criteria for a claim, such as assistance with a required number of activities of daily living (ADL)–even when your own doctor or the experts we have review your case disagree. At Leader & Leader, P.A., we have extensive training, education and experience in long-term care and the applicable insurance from both the medical and legal standpoints.
Not only can we often be of great help and profoundly increase your chances of receiving the benefits you deserve, but in most situations, we can accept the case on a pure contingency basis. That means you, the client, are not responsible for any of our legal fees–win or lose. And, if we win, the fees are typically paid by the insurance company, in addition to your benefits, as opposed to a percentage of your recovery going to your lawyer. In short, in most cases, one hundred percent of the recovery for benefits and/or services to which you were entitled will go to you as they were intended and are not eaten up by legal fees and costs!
When Insurers Fail to Cover Long-Term Care Expenses
Long-Term Care Insurance Overview
Long-term care insurance is intended to provide necessary care when an injury, medical condition or diminished functions interferes with a person’s ability to independently care for him or herself. Long-term care insurance covers costs not usually covered by traditional health insurance or Medicare, or other related Medicare supplemental plans. It is not uncommon for long-term care benefits to reach or exceed an annual cost of $60,000.00 per year or MORE! Benefits available under a long-term care insurance policy may include:
- Help with daily activities in your home (commonly referred to as Activities of Daily Living)
- Adult daycare and other community programs
- Nursing Home Residency
- Adult Living Facility Care (ALF)
- Visits by nurses or other home health care professionals for home health care
- Medical devices
Many long-term care insurance policies contain provisions specifically designed to limit the responsibility of the insurance company or are drafted in a manner that makes it more difficult for policyholders to obtain the coverage and compensation they should be entitled to. It is therefore essential that policyholders’ rights are protected against bad faith insurance practices designed to make it more difficult for individuals to receive the long-term care benefits they are due.
Protecting Your Benefits
Leader & Leader, P.A. is experienced in dealing with insurance companies. We know health care and, more specifically, long-term care, inasmuch as our founding partners have worked in the long-term care arena for over 40 years.
Our attorneys are innovative, skilled, experienced, knowledgeable and aggressive. We have vigorously advocated for our clients’ rights against unfair treatment by insurance companies in a countless number of cases. The following is a list of insurance companies with which you may have a long-term care insurance policy for which you are not getting the benefits you deserve. In many instances, WE CAN HELP and at NO COST to you!
|Aetna||Allianz||American Republic||Bankers Life and Casualty|
|Berkshire Life||Conseco||Continental Casualty Company (CNA)||Genworth (GE)|
|John Hancock||Knights of Columbus||Mass Mutual||MedAmerica|
|MetLife||Mutual of Omaha||Northwestern||New York Life|
|Penn Treaty American||Prudential Financial||State Farm||Unum|
Our background and experience assists us in promptly evaluating your claim and identifying potential shortcomings of your insurance company in the manner they have handled, and often improperly denied your claim. At Leader & Leader, P.A., we are well-versed in the specific procedures involved in pursuing a claim and protecting our clients’ rights under state and federal law. We work tirelessly in order to help policyholders obtain the full limits of long-term care insurance coverage to which they are entitled.
Turn to Expert Long-Term Care Attorneys for Help
There are all sorts of technical legal and/or medical issues in which a long-term care insurance company may attempt to use to deny coverage. For example, some may provide coverage only for specific kinds of treatment and contest requests for in-home care or assisted living based on their hired consultant’s opinion that you do not meet the necessary need for assistance with activities of daily living.
Sometimes it is based on your doctor’s notes, or orders that intend for you to get the treatment but are not written properly. Instead of asking your doctor for further clarification, or to add necessary information or advising you that is all that may be needed, they sometimes merely deny the claim. Your claim for long-term care insurance benefits may also be denied if the insurance company determines that you made the slightest error in a certain step of the process– sometimes as petty as how you filled out a form. Although, they may try to deny coverage on such a basis, it is often not legally justified and can be successfully challenged.
The insurance company knows that once it denies a claim, a large percentage of people will merely accept the denial, thus allowing the company to get off the hook completely for substantial benefit they owe you and/or your family. They know most claimants are not experts in medical or insurance facts and laws that apply, but Leader & Leader, P.A. has the knowledge, skill and experience to combat these improper denials on your behalf.