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. Insurance companies may unjustifiably deny claims for various reasons, including alleged lapses in coverage, disputes over the level of disability, insufficient medical evidence, and discrepancies between the policy terms and the care received. Moreover, the claims process itself can be arduous and convoluted, with insurers leveraging intricate legal language and bureaucratic hurdles to justify denials.
At Kantor & Kantor, we recognize the importance of securing the benefits promised by long-term care insurance policies. With a rich history of success, we have consistently demonstrated our commitment to advocating for policyholders, prevailing against even the most formidable insurance companies.
Our Sacramento long-term care insurance attorneys have an extensive track record and experience fighting and beating insurance companies, and we can use this experience and knowledge to win your long-term care insurance claim.
Contact us at 866-783-1147 for a free consultation to discover how we can leverage our expertise to champion your rights and secure the benefits you deserve.
We offer a free case evaluation to discuss how our attorneys can assist you. Contact us now 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.
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.
For more information about your legal options and to determine if we can assist with your case, contact our Sacramento long-term care 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 long-term care insurance benefits. Here is why choosing Kantor & Kantor is your best choice:
Unparalleled Success Against Insurance Companies
Our lawyers have successfully resolved long-term care 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 long-term care 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 long-term care 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 Sacramento Long-Term Care Insurance Attorneys Can Help
Our experienced Sacramento 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 Sacramento 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 Kantor & Kantor Today
Facing a long-term care insurance battle can be emotionally and financially taxing, but you do not have to navigate this challenging terrain alone. At Kantor & Kantor, we are people helping people, and we stand ready to provide you with the personalized and effective legal support you need.
Our Sacramento long-term care insurance attorneys are committed to advocating for your rights and ensuring that insurance companies fulfill their obligations. We understand the urgency of your situation and are prepared to act swiftly to address your concerns. Contact us at 866-783-1147 for a free consultation.
