California Long-Term Care Insurance Denial Lawyer
Your Case is Our Cause
When you make a claim for long term care insurance benefits, and your claim is denied, it is imperative that you seek assistance from qualified legal counsel. Our long-term care lawyers at Kantor & Kantor have extensive experience fighting long term care insurance companies on behalf of our clients. When you work with our team, you will quickly find that we care deeply about you and the challenges you face. Our extensive list of clients who struggled with long-term care insurance denials gives us a unique perspective on the disruption and stress caused by an unexpected denial of a claim.
Your case is our cause. When you’re treated unjustly by your insurer, our California long-term care denial lawyer is in your corner with the full weight of all our firm’s resources behind you.
Long-term care insurance (LTC) plans are designed to cover caregiver needs for those who are unable to care for themselves, either due to physical problems or the devastation of cognitive incapacity. We can help if the care is is home-based care or is provided in a nursing care facility. That care is always very expensive, and the LTC policy was purchased by forward thinking insureds to prevent financial disaster in the event care became necessary. However, from the insurers point of view, while they are excellent at accepting premiums, proving long term care benefits can be very expensive, and as such, they are equally adept at finding ways to deny claims. When your insurer denies your claim for benefits or discontinues your policy, you are 100% within your rights to challenge this decision. However, far too many policyholders are unaware of their options and fall prey to the insurance company’s unethical conduct.
Regardless of the reason your insurer provides for your claim denial, you should speak with our California long-term care insurance denial lawyer. We provide free, 30-minute consultations and will let you know if you have a case. Give our team at Kantor & Kantor a call today at 818-886-2525 to learn your legal options.
Choosing Kantor & Kantor as Your Long-Term Care Attorney
Rely on Our Expertise and Experience. Count on Our Compassion.
At the end of the day, we are people helping people. We know how a claim denial can upend your life and your loved ones’ lives. Often, the insureds themselves are too frail or cognitively impaired and can’t fight for themselves, and it is their children or spouses who are looking for assistance on behalf of a policyholder. We understand what is at stake, and will fight for you if your long-term insurance claim is denied, or your insurance company cancels your policy in violation of the policy terms or the laws of your State. Our California long-term insurance attorneys at Kantor & Kantor, LLP have the knowledge, expertise, and determination to prevail when advocating on your behalf with your insurance company. With more than 30 years of experience representing insureds both in California and across the country, we know how insurance companies operate and know what strategies to employ to obtain your rightful benefits. Attorney Glenn Kantor’s decades of experience and numerous important cases make him and the other attorneys at Kantor & Kantor an essential legal resource for your case.
What Can Our Long-Term Care Insurance Lawyers Do for You?
We Go to Battle Against Long-Term Care Insurance Companies, No Matter How Large
Our long-term care insurance attorney can help you at any step in the process. We can assist you when you need to…
- File a long-term care insurance claim,
- Dispute a claim denial,
- Handle lapsed policy issues,
- Appeal a denied claim,
- Take your case to court.
California, and many other states, have provisions of their insurance codes dealing specifically with long term care insurance. The legislatures understood that when individuals buy long term care insurance, they are relatively young and healthy, but when they need to actually make a claim, they are typically very ill and/or cognitively impaired. For this reason, there are special insurance laws aimed at protecting long term care claimants. But those laws are complex and understood by only a small percentage of attorneys. Kantor & Kantor attorneys have the necessary experience to protect your rights and give you the best chance of obtaining benefits.
When insurance companies act in bad faith, which means they did not act within their “duty of good faith and fair dealing,.” our long-term care attorneys specialize in taking these cases, and holding the long term care insurers accountable for their actions when they wrongfully deny claims. We have experience in using the law to protect you, and can often obtain settlements well in excess of the contractual benefits. Moreover, we only work on a contingent fee basis, and are paid only if and when we get your claim paid.
It is common for insureds to trust their insurance company and assume they have your best interest in mind when they provide you coverage. Unfortunately, long-term care insurance companies put profits above people, and very often fail to take steps to put your interests at least equal to their own. This results in the denial of what should be payable claims. As the result of our work, and the success we have achieved, we are the firm that insurance companies fear because we don’t settle every case. We are unafraid to take a long-term care insurance company to court, and are ready to fight on your behalf. We will always put your needs at the forefront. When the insurance company treats you like a file number, we treat you like a person.
Reasons for Rejection of Long-Term Care Insurance Claims
Far too many legitimate claims are rejected by long-term care insurance companies. Carriers will look for reasons not to pay your claim. They will contest the extent of your physical or cognitive impairments; they will tell you the facility you have moved to is not covered by your policy, or your caregiver is not properly licensed, even when no license is required. They look for any reason NOT to pay your claim. If you believe your claim was unfairly denied, talk with our attorneys who have chosen this field of law because they care about your rights and health. We will fight fiercely to obtain the full benefits you deserve.
When Should Your Long-Term Care Insurance Claim Be Approved?
Our California Long-Term Care Lawyers Know Tactics Insurers Use to Deny Claims
Many people pay their premiums for years before they need to file a claim. You may be among them. When you purchased your long-term care policy, perhaps you assumed that when you were unable to care for yourself, you could file a claim and with confidence that your needs would be met. You assumed your claim for long-term care would be approved, and your insurer would pay for your caregiver needs. At Kantor & Kantor, our attorneys know all too well, that assumption may be wrong. If you need the help of our long-term care lawyer, then you probably received a terrible shock when your insurance claim was denied.
The typical reasons for denial relate to:
- Who provides the care:
- Is it a skilled medical professional, like a nurse?
- Benefit eligibility:
- Is the policyholder cognitively impaired?
- Can the policyholder perform all their basic daily activities?
- Lapse of coverage:
- Did the policyholder miss a premium payment?
Our California long-term care insurance attorneys are all too familiar with tactics insurance companies use to deny claims and we are skilled at fighting those denials.
Long-term care services can be very expensive, so insurance companies are highly motivated to deny claims and protect their bottom line. Long-term care is a comprehensive variety of supportive services for people of all ages who are unable to care for themselves due to physical or cognitive disability. LTC comprises a wide range of services, whether at home, in a community-based program, in an assisted living facility, or in a nursing home.
The majority of LTC services do not necessitate the use of a trained healthcare practitioner. Yet, some policies will not cover in-home care by a relative, even though that is who frequently handles this role. These policies insist that caregiving services must be supervised by a nurse. This applies even when the policyholder does not need medical care.
Such a limitation is one of many approaches LTC insurers use to deny claims. When policies also require that the policyholder pays for care for a set length of time before the policy takes effect, the requirement of a nurse’s supervision can be financially difficult, if not impossible. Other LTC insurance only pays benefits for care in institutional settings, like nursing homes and assisted living facilities, but others will cover at-home assistance. Costs for caregivers can vary greatly, depending on the setting in which that care is provided.
Are You Able to Perform Activities of Daily Living?
Long-term care insurance provides benefits to pay for care if you are no longer able to perform at least two “activities of daily living” (ADL) or if you have a “severe” cognitive impairment (which would also render you unable to perform your ADL). There is a wide range of benefits that long-term care policies offer. They may provide care for only certain types of illnesses; they may provide care for the remainder of the policyholder’s life or may be capped at a set number of years.
Regardless of the type of care your policy covers, you must first pass the ADL “test” for your claim to be approved. There are several reasons an insurer might deny a long-term care insurance claim, but one our attorneys see too often is the assertion that the insured is still able to handle all activities of daily living.
Activities of daily living include:
- Bathing and personal hygiene, like tooth brushing and shaving.
- Using the toilet.
- Continence, which is control of bladder and bowel functions or the care of a catheter or colostomy bag.
- Ambulating (for most people, walking is how they move their body throughout the day.)
- Transfer (the ability to get oneself in and out of a chair or bed.)
- Eating (the ability to bring food to your mouth so you can eat it.)
- The insured is unable to safely care for themselves due to cognitive impairments, and leaving them alone would be a danger to themselves or others.
Again, if you are unable to perform two (or sometimes, three) or more ADLs, then you can qualify for long-term care insurance. What activities an insurance claims administrator determines a person can do on their own can be the grounds for denial of a claim. While loved ones may know if their relative is unable to safely manage basic daily tasks, an insurance company representative sees only a snapshot in time, or brief written documentation, and determines from that selective amount of information someone’s ability to care for themselves.
A claims administrator will look hard for a reason to deny a long-term care insurance claim. Their quick determinations about a policyholder’s ability to manage their ADLs may put that person in danger and subject their loved ones to a role of caretaking for which they should not have to be responsible.
Our Client’s Story: Unjust Denial of a Long-Term Care Insurance Claim
Here’s an example of one of our clients whose long-term care claim was denied:
She was a 93-year-old former schoolteacher whose daughter called daily to check in. Shortly after one of those calls, she fell in the bathroom and couldn’t get up. She remained there until her daughter found her the next day, when she wasn’t able to answer her daughter’s call. Upon being examined by a doctor, the medical professional determined she was not safe to be left home alone. Though she wasn’t cognitively impaired, she was too frail.
Like many LTC policies, hers had a clause that she had to pay for her own caretaking help for a set time frame, called an “elimination period.” After that time, the LTC policy benefits would kick in. The daughter hired a nursing student to help her mother from morning until bedtime. When she filed the long-term care insurance claim, the administrator requested details about what care the nursing student offered her, so she provided written details about what she did each day.
Because each day was generally the same, after detailing those activities on the first day, the student described the morning caretaking activities on subsequent days as “performing morning routine.” While the insurer agreed to cover the costs of care for the first day, it denied coverage for all subsequent days claiming it didn’t know what the “morning routine” was. Our long-term care attorney successfully argued that the company failed in its fiduciary duty to call our client to clarify what that wording meant. It simply made the determination without contacting her.
The insurance company offered a settlement of $1 million to our client. Our attorneys are highly experienced litigators and, given our history of other victories in court, we were confident we could win $10 million by taking the case to trial. When we advised our client of this large amount, she requested we simply take the $1 million. Why? Because she felt she may pass away in the time it would take to complete the trial process. Rather than leave her family with nothing, she wanted the $1 million that was a certainty in the moment.
Our team at Kantor & Kantor always puts clients first. While we were fully confident we could win $10 million at trial, we understood why our client wanted to settle for only $1 million. We supported her decision and were glad we could bring her justice when the long-term care insurance company’s denial of her claim was so clearly unjust.
Unlock the answers to your Long Term Care Claims questions with our extensive FAQ section. We’re here to empower you with knowledge and guidance. When you’re ready to take the next step in securing the care you deserve, count on the experienced team at Kantor & Kantor to stand by your side.
Handling Lapsed Policy Disputes
Sometimes a long-term care insurance policy may lapse because a policyholder may forget to make a premium payment. Missing one premium payment can result in a lapsed policy. However, the reasons for the lack of payment may relate to the policyholder’s failing cognitive abilities. If an elderly policyholder has cognitive impairment, they may simply forget to make a payment. Perhaps they suffer a health emergency, leaving the policyholder unable to attend to their finances. They pay a premium for years and then suddenly forget to do so or are unable to. Luckily, California has a safeguard in place that now prevents this lapse by requiring the insurance company to put in place a procedure whereby a second person will receive notice before the policy is canceled (CA Ins. Code INS §10235.40). This same law requires a reinstatement period of five months during which time past premiums can be paid if the insured is proven to have, “cognitive impairment or loss of functional capacity.”
In one case we recently handled, the insurance company incorrectly entered our client’s submission of a change of address, so premium notices were never received. Furthermore, the company failed to obtain a second person to receive lapse of payment notices. When our client filed a claim for long-term care, it was denied. Our attorneys successfully fought this unjust denial and won our client a substantial settlement.
If a claim is denied based upon a lapse in coverage, the legal remedy typically is to bring a bad faith lawsuit against the insurance company. In California, that denial of a long-term care insurance claim may even be seen as elder abuse because it causes emotional distress.
The best way to determine whether your long-term care insurance claim denial is unjust is to speak with one of our attorneys specializing in long-term care insurance. Call Kantor & Kantor today at 818-886-2525.
What to Do When Your Long-Term Care Claim is Denied
Get Help from Our Skilled Long-Term Care Insurance Attorney
Bad faith laws are extremely complex. To be sure you have the best opportunity to win the settlement or trial award you deserve, get legal representation from an attorney who has handled a large number of cases. If you are unsure of your options, contact our California long-term care insurance lawyers at Kantor & Kantor LLP. We will review the reason for the denial and advise you on the next steps to take. Call us at 818-886-2525 to schedule your free case review.
We give anybody a 30-minute consultation – if you don’t know whether you need an attorney, call us. Rely on our experience and knowledge. Even our legal colleagues know Kantor & Kantor is the law firm you should hire. Ask a judge. Ask a mediator. Ask a lawyer in another practice area. They will all tell you they would recommend Kantor & Kantor, LLP.
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]