According to statistics, long-term care expenses average $60,000 per year. This is why many individuals purchase long-term care insurance, to help pay for their long-term care needs in case they require it. This is especially true since long-term care expenses are not covered by private health insurance or Medicaid. Because of these factors, long-term care insurance premiums can be expensive.
To qualify for coverage, the policyholder must be physically disabled or have a cognitive impairment, such as someone who can no longer perform activities of daily living (ADL). This includes activities such as bathing, dressing, walking, moving from bed to chair, toilet, maintaining continence, and eating.
Other benefits under your long-term care insurance policy may include coverage for adult daycare services, nursing home care, visits by nurses or other home health care professionals, medical devices, and transportation.
Unfortunately, sometimes long-term care insurance companies deny valid long-term care insurance benefit claims. This can quickly cause financial and emotional turmoil for both you and your family.
Some of the reasons long-term care insurance companies use to unfairly delay or deny a claim include:
- Failure to seek hospital care prior to requesting long-term care;
- Lack of an acute medical condition requiring long-term care;
- Long-term care services were provided by an unqualified professional or service provider;
- Long-term care services required are covered by Medicare;
- Long-term care services provided are not covered;
- You can perform "Activities of Daily Living;"
- Long-term care services provided are unrelated or unnecessary;
- Failure to provide ongoing verification of long-term care needs;
- Long-term care services required are related to a "Pre-existing condition;"
- Policy was cancelled due to "Non-Payment of Premiums;"
- Failure to provide a timely "Notice of Proof of Claim;"
- Misrepresentation of material facts on your initial application for insurance.
Insurance claims lawyer J.P Gonzalez-Sirgo has been representing insureds in insurance claims since 1994 and along with an experienced team we hold insurance companies to their word. We do exactly what insurance companies fear: We hold them to the promises that they made in the insurance policy that they sold you.
Insurance claims advocate attorney J.P. Gonzalez-Sirgo helps insurance policyholders recover what they are due on their insurance claims.