Long-term care insurance policies cover the long-term care needs of persons that cannot live independently and maintain a minimum quality of life.  Some of the most common conditions that may cause a person to require long-term care include head injuries, strokes, heart disease, Parkinson's disease, Multiple Sclerosis, Alzheimer's disease, dementia, fractured bones from a fall, and recovery from an illness, injury or surgery.     

According to statistics, long-term care expenses average $60,000 per year.  This is why many individuals purchase long-term care insurance.  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 benefits, the policyholder must be physically disabled or have a cognitive impairment, such as someone who can no longer perform activities of daily living (ADL), like 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.

You can reach 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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