Long-term care insurance provides benefits to an individual who, as a result of chronic illness or disability, is no longer able to perform daily activities. Policy benefits are designed to assist with costs not typically covered by Medicare or Medicaid, such as those related to in-home care, assisted living facilities or nursing homes. The expenses of long-term care average $60,000 per year, and some experts predict that this figure will rise to $200,000 by the year 2030.
Unfair Denial of Long-Term Care Benefits
Although thousands of elderly Americans have received vital care as a result of their long-term care policies, many insurers are making it nearly impossible for its policyholders to obtain benefits. In fact, in the state of California, nearly 25 percent of all long-term care insurance claims were denied in 2005. This is according to the New York Times, which reviewed more than 400 grievances and suits filed against long-term care insurers. During interviews with current and former employees of major long-term care insurer Conseco, it was revealed how valid claims were routinely denied for trivial reasons. The Times also cited other startling examples of long-term care insurance denial, including the following:
- In 2003, Bankers Life and Casualty sent an 85-year old woman incorrect paperwork, then denied her claim because she completed the wrong form.
- Insurer Penn Treaty American terminated the benefits of a 92-year old man, forcing him to leave his nursing home despite his obvious medical ailments.
- In 2002, a 65-year old woman was denied long-term care benefits after her insurer, Conseco, contested the fact that she was ailing enough to require assisted living.
Has Your Long-Term Care Claim Been Denied?
Every long-term care insurance policy contains an implied promise from the insurer to act in good faith. Insurance companies that fail to do so can be held accountable for their actions. If you or a family member has been denied a legitimate claim or have had your long-term care benefits terminated, an attorney with experience in dealing with these types of claims can help you learn more about your rights.
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