You have faithfully paid premiums over the years, and it can be devastating and, potentially, life-ruining when the insurance company fails to fulfill its commitments. Long-term care insurance (LTC) providers can reject claims, even when the claims are valid. When a long-term care claim is denied, a person is unable to receive the round-the-clock care they need. This can render individuals unable to take care of themselves while simultaneously facing the enormous financial burden forced upon them by insurance companies.
LTC insurance is a vital component of your financial and healthcare planning. It offers a safety net for those unexpected moments when assistance with daily activities or skilled nursing care becomes necessary.
We understand the devastation of denied claims, delayed payments, and coverage disputes. We are more than just attorneys—we are people helping people. Our Fresno LTC insurance attorneys are committed to guiding you through every step of the LTC insurance process.
If you are facing challenges with your LTC insurance policy, contact Kantor & Kantor at 818-886-2525 for a free consultation.
What is Long Term Care Insurance?
Long-term care insurance is an insurance policy designed to cover the costs of long-term services and support, including personal and custodial care. This care is typically provided in various settings, such as the insured person’s home, an assisted living facility, or a nursing home. The primary purpose of long-term care insurance is to help individuals manage the potentially high costs associated with long-term care due to chronic illness, disability, or aging.
Qualifying for LTC insurance involves meeting specific criteria related to age, health, and the insurance company’s underwriting guidelines. Insurance companies assess potential policyholders based on factors that predict their likelihood of needing long-term care in the future. The six Activities of Daily Living (ADLs) are basic self-care tasks that are essential for independent living and these tasks are commonly used to assess a person’s ability to function and determine the level of care they may require, particularly when applying for long-term care insurance or benefits. The inability to perform a certain number of these ADLs often qualifies a person for assistance or long-term care benefits.
The following are the six ADLs:
- Bathing: The ability to wash oneself in the bath or shower, including the ability to get in and out of the tub or shower safely.
- Dressing: The ability to select and put on appropriate clothing, as well as being able to take the clothes off when needed. This also includes tasks like fastening buttons and zipping zippers.
- Eating: The ability to feed oneself, including bringing food to the mouth and chewing/swallowing, but not necessarily the ability to prepare meals.
- Transferring: The ability to move from one place to another, such as getting in and out of bed, standing up from a chair, or moving to and from a wheelchair.
- Toileting: The ability to use the toilet, including getting on and off the toilet, maintaining hygiene, and managing personal hygiene related to continence.
- Continence: The ability to control both bladder and bowel functions or manage incontinence effectively if necessary.
However, generally, there are two separate ways to qualify for LTC insurance: Be physically impaired and thus unable to perform two of the six ADLs; or have severe cognitive impairment.
We offer a free case evaluation to discuss how our attorneys can assist you. Contact us now at 818-886-2525 for your free consultation.
Why Was Your LTC Claim Denied?
While LTC policies offer valuable protection, policyholders face various challenges when accessing benefits. Below are some common obstacles policyholders may encounter:
1. Substantive Denial of Claims
One of the most frustrating challenges policyholders face is the denial of their insurance claims due to disputes over the necessity of the care provided.
2. Policy Lapses and Cancellations
Policyholders may inadvertently allow their LTC insurance policies to lapse or be canceled due to missed premium payments or other administrative errors. While your policy may lapse, insurance companies must alert you to the lapse and provide proper notice. Further, lapses can, and do, occur as a result of the insurance company’s error. If you notice the mistake before you need to make a claim, the insurer will often require you to reapply for the insurance and deny coverage.
3. Coverage Disputes
Disputes over what services are covered under a LTC insurance policy are not uncommon. Policyholders may disagree with their insurance companies regarding the scope of coverage for specific care services, leading to confusion and frustration. These disputes can prolong the claims process and create additional stress for policyholders and their families.
For example, while some policies cover at-home nursing care, other policies only cover nursing homes. All policies have requirements for both. Ultimately, even if an insurer agrees that a person needs and qualifies for care, the insurance company may argue that the person is not receiving care from a qualified person/entity in order to deny a claim.
Our attorneys at Kantor & Kantor will help you gather all medical records and other documentation. Contact us today at 818-886-2525.
Why Choose Kantor & Kantor?
When navigating the complexities of LTC insurance claims, choosing the right law firm can make all the difference. At Kantor & Kantor, we are committed to providing exceptional service and achieving the best possible outcomes for our clients. Here are some reasons why you should choose us:
Experienced Attorneys
Our attorneys focus on insurance law and have extensive experience representing clients in various types of insurance cases. We understand the intricacies of LTC insurance policies and know how to effectively advocate for our client’s rights.
Proven Track Record
With a history of successful case outcomes against insurers and successful LTC settlements for clients, we have built a reputation for excellence in the legal community. We have helped numerous clients secure the benefits they deserve, even in the face of denied claims and complex legal challenges.
Tenacious Advocacy
We are relentless when pursuing justice for our clients. When insurance companies act in bad faith or unfairly deny claims, we do not hesitate to challenge them. Our lawyers are skilled negotiators and formidable litigators who will fight for your deserved benefits.
Comprehensive Legal Support
From the initial consultation to your case’s resolution, we provide comprehensive legal support. We handle all aspects of your claim, including policy review, claim filing, appeals, and litigation. Our holistic approach ensures no detail is overlooked and you receive the full legal services needed to secure your benefits.
How Our Fresno Long-Term Care Insurance Lawyers Can Help
Our experienced Fresno LTC insurance lawyers have the knowledge and expertise to provide comprehensive support and representation, ensuring you receive the benefits you deserve. Here is how we can assist you:
1. Complete Policy Review
The dense and often confusing language can make understanding your LTC insurance policy difficult. Our team will meticulously review your policy to identify the coverage details, benefits, exclusions, and any potential issues that might arise. We will explain the terms in plain language, ensuring you fully understand your entitlements and obligations.
2. Claim Filing Assistance
Filing a LTC insurance claim requires detailed documentation and strict adherence to the policy’s procedures. Our attorneys will assist you in preparing and submitting your claim, ensuring all necessary documentation is included and accurately completed. By proactively managing the claim filing process, we help minimize the risk of delays or denials.
3. Appealing Denied Claims
Insurance companies may deny claims for different reasons, often leaving policyholders feeling helpless. If your claim has been denied, our Fresno LTC insurance lawyers will conduct a thorough investigation to understand the basis of the denial. We will then prepare a comprehensive appeal, challenging the denial with strong legal arguments and supporting evidence. Our team is dedicated to reversing unjust denials and securing the benefits you deserve.
4. Addressing Policy Lapses
Policy lapses or cancellations can occur for various reasons, including missed payments or administrative errors. If your policy has lapsed, we will investigate the circumstances and work to reinstate your coverage. We will also advise you on steps to prevent future lapses, ensuring continuous coverage and protection.
5. Coverage Disputes
Disputes over what services are covered under your policy, or the manner in which they are covered, can lead to confusion and denial of necessary care. Our lawyers are adept at interpreting policy language and will advocate for your rightful coverage. We will engage with the insurance company to clarify ambiguities and ensure you receive the full range of benefits your policy provides.
6. Litigation Support
In some cases, legal action may be necessary to secure your benefits. Our firm is prepared to take your case to court if needed. With extensive experience in litigation, our attorneys will build a compelling case and represent you vigorously in legal proceedings.
Contact Our Fresno Long-Term Care Insurance Attorney Today
Whether you are dealing with a denied claim, delayed payments, or coverage disputes, time is of the essence. During your consultation, we will take the time to understand your unique situation and provide advice tailored to your needs. With our experienced Fresno LTC insurance lawyers, you can trust that your case is in capable hands.
Contact us at 818-886-2525 to schedule your free consultation and take the first step toward securing your future and peace of mind.
Attorney Glenn R. Kantor
Glenn Kantor is a founding partner of Kantor & Kantor LLP. As a young attorney, Glenn saw the injustice of wrongful insurance denials and created a law firm to represent individuals seeking to obtain their rightful benefits. Glenn is committed to ensure that clients receive the benefits they are entitled to under their insurance policies or group health plans. [Attorney Bio]
