What Florida Policyholder Need to Know about Long-Term Care Insurance

J.P. Gonzalez-Sirgo
Founder of J.P. Gonzalez-Sirgo, P.A.

The American Association for Long-Term Care Insurance reports that approximately 8 million people in the U.S. have long-term care coverage.  Approximately half of the claims made under long-term care policies are filed by policyholders that are at least eighty-years-old.  The purpose of this form of coverage is to pay for those expenses not covered by Medicare.  Because this form of coverage can have a dramatic impact on the care received by seniors or those who suffer from a chronic illness, we have provided some basic information all policyholders should know about long-term care insurance.

Minimum Coverage Typically Includes In-Home Coverage

If an insured needs in-home care, certain minimum requirements must be satisfied before in-home care services can be provided.  The insured must be unable to provide for at least three types of his or her daily needs, such as personal hygiene and meal preparation.  If the insured suffers from dementia or Alzheimer’s disease, the insured can qualify for in-home care that is not provided by Medicare.  However, different policies will be subject to their own exclusions, conditions and limitations, so you should carefully review your long-term care policy if you have questions about coverage.

Denial of Long-Term Coverage in Florida

When an elderly loved one needs long-term care in his or her residence or a nursing home, a long-term care policy can provide critical coverage.  Many policyholders in this situation find that their claims are denied.  If this happens, policyholders should seek legal advice from an experienced Florida long-term care insurance attorney.  Your attorney can take on the insurance company and protect your interests.  Because the fundamental function of long-term care policies are to defray the costs of skilled nursing care or in-home care, a denial can mean going without critical supportive care.  This inability to obtain proper care also can result in a threat to the insured’s health and safety.  Generally, policyholders can improve their chance of having their claim approved by applying as soon as assistance is needed.

There are a number of key facts you should be aware of if you need to file a claim under your long-term care insurance:

Delays in Filing Can Damage Your Claim- As a general rule, you should not procrastinate in terms of filing a claim under your long-term care policy.  Delays may be construed as evidence that you do not need assistance.  The insurer will contend that if you required assistance you would have filed your claim earlier.

Terms/Deductibles: Policyholders should carefully review their policy, so there are no surprises in term deductibles, exclusions or limitations on coverage.

More Than Nursing Home Coverage: Although some people think long-term care policies only apply to nursing home care, these insurance policies also provide coverage for assisted living and in-home care.

If you have questions about Miami-Dade homeowners insurance claims, as an experienced Miami long-term care insurance attorney, I can answer you questions thoroughly. My law firm represents policyholders in claims disputes in Miami and throughout Florida.  The Law Firm of J.P. Gonzalez-Sirgo, P.A. offers free consultations and case evaluations.  No Recovery, No Lawyer Fees.  Call 305-461-1095 or Toll Free 1-866-71-CLAIM.

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