Long-term care insurance is one of the most overlooked types of coverage because people often procrastinate in planning for future nursing home or in-home care.  Although no one wants to contemplate the possibility of suffering a disabling injury in a car accident, an incapacitating illness like cancer, or mental impairment from Alzheimer’s disease, these conditions cause debilitation to many people every year.  Long-term care insurance can provide essential coverage for families trying to avoid depletion of a family’s financial legacy to cover the enormous cost of a skilled care facility.  The financial consequences of a denial of a long-term care insurance claim can be devastating.  Below we provide answers to important questions about this type of coverage.

What exactly is long-term care insurance?

In the most general terms, the role of long-term care is to enable people to function as normally as possible for the longest period of their lives.  Supportive care of this type is designed to assist individuals with the basic functions of daily life over an extended period.  Although many people presume that long-term care is only relevant to people who are elderly, some studies indicate that approximately 4 in 10 individuals who need this type of assistance are under the age of 65. 

Although some people rely on Medicare for these costs, there are limitations and restrictions that make this coverage option less than ideal.  Medicare has strict financial eligibility qualifications that require depletion of the value of the assets in the claimant’s estate.  Even when all of the conditions required for Medicare eligibility are satisfied, Medicare only provides full coverage of nursing home care for twenty days.  Partial payment might be available for a hundred days depending on the facts and circumstances.  Further, this public health insurance option requires a three day hospital stay before nursing home care is covered.  The injury or illness that necessitated the hospital stay also must be related to the nursing home care to cover this form of residential support.  The coverage also terminates if the patient’s needs shift from skilled care to custodial care.

Do you need a power of attorney if you want to assist a loved one in obtaining legal representation when a long-term care insurance claim has been denied?

The answer to this question depends to a significant extent on the unique circumstances of the situation.  When you are helping someone complete forms that they can understand and answer, you do not require a power of attorney before meeting with a long-term care insurance lawyer.  However, you will need to obtain a power of attorney if you need to sign legal papers on behalf of the claimant or access personal medical and insurance information for the disabled individual.  If you are unsure how to proceed, the best option might be to schedule a consultation with a lawyer.

Does your incapacitated loved one require an insurance claims attorney?

Although you can seek assistance by contacting the State Insurance Commissioner or State Department of Insurance, these agencies offer limited assistance.  A lawsuit that seeks recovery for breach of contract and/or insurance bad faith damages for a claimant can only be filed by a licensed attorney.  Because state agencies that regulate insurance carriers often are understaffed and underfunded, these complaints can take an extended period to be resolved.  The complaint along with any accompanying delay can result in potential prejudice in terms of a lawsuit.  If you plan to file a complaint, the best practice is to talk to an experienced insurance claims attorney first to determine any potential adverse impact on a future lawsuit.

You can reach Miami Insurance Claims Lawyer J.P. Gonzalez-Sirgo by dialing his direct number at (786) 272-5841, calling the main office at (305) 461-1095, or Toll Free at 1 (866) 71-CLAIM or email Attorney Gonzalez-Sirgo directly at [email protected].

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