When you have invested in long-term care insurance to protect your future, it is natural to assume that those benefits will be there for you when you need them most. But when your legitimate claim is denied, the impact can be more than just overwhelming – it can be emotionally and financially devastating. Long-term care (LTC) insurers often reject claims, leaving individuals without access to essential care while simultaneously facing significant financial burdens.
At Kantor & Kantor, we know how overwhelming this can be. Our team is here to fight for you. With years of experience successfully overturning denied claims, we are committed to holding insurance companies accountable and ensuring you get the benefits you are rightfully owed. If your LTC insurance claim has been denied, contact our Orange County team at 818-886-2525 for a free consultation. Let us help you secure the coverage you deserve. We take pride in being people helping people, and we look forward to helping you.
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 LTC 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. 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 LTC 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: being physically impaired and thus unable to perform two of the six ADLs or having severe cognitive impairment.
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 that 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. Lapses can, and do, occur because 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 an 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 cover only nursing homes. 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 to deny a claim.
For more information about your legal options, contact our Orange County LTC insurance attorneys at 818-886-2525.
Why Choose Kantor & Kantor?
At Kantor & Kantor, our commitment to excellence goes beyond mere legal representation – it includes a dedication to ensuring that every client receives the full extent of their LTC insurance benefits. Here is why choosing us is your best choice:
Unparalleled Success Against Insurance Companies
Our lawyers have successfully resolved LTC claims against various insurance companies. We have faced the industry’s giants and emerged victorious, securing rightful benefits for our clients. When you choose Kantor & Kantor, you align yourself with a legal team known for achieving positive outcomes.
Personalized and Compassionate Approach
We understand that LTC insurance claims involve personal and often sensitive matters. Our team approaches each case with the empathy it deserves. We take the time to understand your unique situation, tailoring our strategies to your needs. Your concerns become our priorities.
Advocacy For Your Rights
Long-term care insurance claims can be complicated, and insurance companies may employ tactics to deny or delay rightful benefits. We are unwavering in our commitment to challenging these tactics. We tirelessly advocate for your rights, ensuring that insurance companies fulfill their obligations and provide the benefits you deserve.
Strategic Advocacy
We approach each case with a strategic mindset, meticulously analyzing the facts and crafting customized legal strategies to maximize the chances of success. Whether through negotiation, mediation, or litigation, we tenaciously advocate for our clients’ rights at every stage of the legal process.
Proven Success
Our firm has a long history of successfully resolving complex LTC claims against many insurance companies. We have secured substantial settlements and favorable results for our clients, demonstrating our ability to navigate the intricacies of insurance law effectively.
Some of the companies we have triumphed against include:
- Unum
- Reliance Standard LTD
- Lincoln Financial
- Prudential
- Hartford
- CIGNA
- MetLife
- SunLife.
How Orange County Long-Term Care Insurance Attorneys Can Help
When you are facing a denied LTC insurance claim, it can feel like you are in a battle with no end in sight. But with Kantor & Kantor by your side, you will have experienced attorneys who know exactly how to navigate these tricky waters. Here is how we can assist you:
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.
Claim Filing Assistance
Filing an 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.
Appealing Denied Claims
Insurance companies may deny claims for different reasons, often leaving policyholders feeling helpless. If your claim has been denied, our Orange County 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.
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.
Coverage Disputes
Disputes over what services are covered under your policy, or the way 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.
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 Kantor & Kantor Today
Do not let a denied LTC insurance claim strip you of the coverage you have worked hard to secure. You deserve the peace of mind that comes with knowing your future care needs are covered. When insurance companies fail to honor their commitments, you need experienced advocates by your side who will not back down.
At Kantor & Kantor, we are relentless in our pursuit of justice for policyholders. Our proven track record of success shows that we know how to take on even the toughest insurance companies—and win. If your claim has been unfairly denied, you do not have to face this battle alone.
Contact us today at 818-886-2525 for a free consultation. Let us fight for your rights and ensure you receive the LTC benefits you deserve.
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]
