Whether you are facing denials, delays, or disputes with your insurance provider, we understand the devastation and toll these challenges can bring. Our mission is to navigate the legal intricacies of your claim and offer a compassionate hand to hold throughout the process. We believe everyone deserves access to the care they need, and we are here to ensure that your insurance policy delivers on its promises when you need it most.
With Kantor & Kantor by your side, you can trust that your rights will be protected, your concerns will be heard, and your interests will be fiercely championed. Our San Francisco LTC insurance attorneys understand that the stakes are high when it comes to LTC, and we are committed to helping you secure the benefits and resources necessary to plan for a secure and dignified future.
If you are ready to take control of your LTC insurance claim and ensure your needs are met, contact us at 415-943-2117 for a free consultation. Let us be your trusted partners on the journey toward peace of mind and financial security.
We offer a free case evaluation to discuss how our attorneys can assist you. Contact us now at 415-943-2117 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.
Reasons for LTC Insurance Claim Denials
Facing a denial of your LTC insurance claim can be a distressing experience, especially when you or your loved one needs critical support and care. Here are some common reasons for claim denial and how our legal team can help you address them:
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.
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.
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 San Francisco long-term care insurance attorneys at 818-886-2525.
Why Choose Kantor & Kantor?
When it comes to matters as critical as navigating LTC insurance claims, selecting the right legal representation can make all the difference. At Kantor & Kantor, we believe our firm stands out for several compelling reasons:
Specialized Expertise
LTC insurance claims require a nuanced understanding of insurance law and the specific provisions within these policies. Our San Francisco LTC insurance lawyers focus on this area, with years of experience advocating for policyholders navigating the complexities of LTC insurance.
Consistent Success Record
We have a history of success in handling LTC insurance claims. Our firm has achieved numerous favorable outcomes for our clients, securing the benefits they are entitled to under their policies. Our track record speaks to our ability to effectively advocate for our client’s rights and interests.
Client-Centered Approach
At Kantor & Kantor, we prioritize the needs and concerns of our clients above all else. We understand that each client’s situation is unique, and we take the time to listen carefully to their circumstances. Our personalized approach ensures we tailor our legal strategies to meet each client’s needs and goals.
Results-Driven Approach
Our primary goal is to deliver results. Whether negotiating with insurance companies, advocating in court, or pursuing alternative dispute resolution methods, we are unwavering in pursuing the best possible outcome for you.
How San Francisco LTC Insurance Attorneys Can Help You
Here is how our attorneys can assist you with your LTC insurance case:
- Case Evaluation: Our experienced San Francisco LTC insurance attorneys will start by thoroughly evaluating your case. During this meeting, we will listen to your concerns and review your insurance policy, medical records, and any other relevant documentation to assess the strengths and weaknesses of your claim.
- Legal Strategy: Based on our evaluation, we will develop a strategic legal plan tailored to the unique circumstances of your case. Whether your claim involves a denial of benefits, a dispute over coverage, or any other issue, we will identify the most effective legal arguments and tactics to pursue a favorable outcome.
- Claim Preparation: Our attorneys will assist you in gathering the necessary documentation and evidence to support your claim. This may include medical records, policy documents, insurance company correspondence, and other relevant information. We will ensure that your claim is thoroughly prepared and presented in the most compelling manner possible.
- Appeals Representation: If your claim is denied or disputed by the insurance company, our attorneys will represent you in the appeals process. We will review the reasons for the denial, gather additional evidence if necessary, and craft persuasive legal arguments to challenge the decision and advocate for the reversal of the denial.
- 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.
In cases where litigation is necessary to resolve disputes with the insurance company, our skilled litigators will also represent you in court proceedings. We have extensive experience litigating LTC insurance cases and will work to protect your rights and pursue a favorable outcome on your behalf.
Schedule a Meeting with Our San Francisco LTC Insurance Lawyers Today
Contact us today at 415-943-2117 to schedule a free consultation with our San Francisco LTC insurance lawyers and learn how we can assist you in protecting your rights and securing your future. Let us put our experience and dedication to work for you.
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]
