Were Your Long Term Care Insurance Benefits Denied? Get the Benefits You’re Entitled To
Hi, I’m Erin
My life’s calling is to hold insurance companies accountable for the promises they make.
Our law firm focuses exclusively on Arizona disability benefits law and we’d love to help you out.
Were Your Long Term Care Benefits Denied? We Are Here to Help.
If your long-term care benefits were denied, you are in the right place. Don’t give up on pursuing the benefits that you deserve. You paid the premiums for the policy in the unfortunate event you ever needed it. Read below for all the details you need if you are facing a long term care benefits denial.
What is Long-Term Care Insurance?
Long-term care insurance (LTC) is a type of insurance coverage that will help pay for the care that you require in the event that you become disabled. Types of care that may be covered by an LTC policy may include:
- Nursing home care
- Assisted living
- Adult day care services
- Home health care
- Home modifications
- Care coordination services
There two main types of LTC policies, and sometimes they are a blend of both: indemnity and reimbursement. Indemnity policies pay you a set amount as a daily benefit, regardless of the actual cost of your case. Indemnity policies are similar to cash benefit policies, which also pay a particular benefit amount per day. Reimbursement policies pay up to a certain daily benefit limit depending on the cost of your care. If your care costs more than that daily benefit amount, you will be responsible for paying for the additional cost of your care. Knowing what type of LTC policy you have is an essential component of understanding your benefits, and we can review your LTC policy to help you understand your coverage.
LTC plans were more prevalent in previous decades, and very few insurance providers offer LTC plans nowadays. This is due to the fact that LTC plans are often very costly for the insurance company to pay out. Now that insurers are realizing the financial liability of LTC plans, we are seeing an increased number in LTC benefit denials. If your LTC benefits have been denied, contact us here. We can help, and you should not walk away from your benefits without consulting with an attorney first.
HOW CAN I GET MY LONG-TERM CARE BENEFITS?
Every LTC policy is different, but generally, in order to receive LTC benefits, you have to prove that you suffer from cognitive impairment or need assistance with two (2) or more of six (6) primary Activities of Daily Living (ADLs).
Were Your Long Term Care Benefits Denied? We Are Here to Help.
If your long-term care benefits were denied, you are in the right place. Don’t give up on pursuing the benefits that you deserve. You paid the premiums for the policy in the unfortunate event you ever needed it. Read below for all the details you need if you are facing a long term care benefits denial.
What is Long-Term Care Insurance?
Long-term care insurance (LTC) is a type of insurance coverage that will help pay for the care that you require in the event that you become disabled. Types of care that may be covered by an LTC policy may include:
- Nursing home care
- Assisted living
- Adult day care services
- Home health care
- Home modifications
- Care coordination services
There two main types of LTC policies, and sometimes they are a blend of both: indemnity and reimbursement. Indemnity policies pay you a set amount as a daily benefit, regardless of the actual cost of your case. Indemnity policies are similar to cash benefit policies, which also pay a particular benefit amount per day. Reimbursement policies pay up to a certain daily benefit limit depending on the cost of your care. If your care costs more than that daily benefit amount, you will be responsible for paying for the additional cost of your care. Knowing what type of LTC policy you have is an essential component of understanding your benefits, and we can review your LTC policy to help you understand your coverage.
LTC plans were more prevalent in previous decades, and very few insurance providers offer LTC plans nowadays. This is due to the fact that LTC plans are often very costly for the insurance company to pay out. Now that insurers are realizing the financial liability of LTC plans, we are seeing an increased number in LTC benefit denials. If your LTC benefits have been denied, contact us here. We can help, and you should not walk away from your benefits without consulting with an attorney first.
HOW CAN I GET MY LONG-TERM CARE BENEFITS?
Every LTC policy is different, but generally, in order to receive LTC benefits, you have to prove that you suffer from cognitive impairment or need assistance with two (2) or more of six (6) primary Activities of Daily Living (ADLs).
Hi I’m Erin,
My life’s calling is to hold insurance companies accountable for the promises they make.
My law firm focuses exclusively on Arizona disability benefits law and we’d love to help you out.
What are “Activities of Daily Living” (ADLs)?
ADLs are activities that every person needs to be able to do independently in order live on their own without assistance. These activities are widely recognized as the following:
Hygiene includes bathing and general grooming necessities.
Dressing includes being able to appropriately dress and undress oneself.
Eating includes having the ability to feed oneself, but not necessarily the ability to prepare food for oneself.
Transferring includes the ability to move between standing and sitting positions, get in and out of bed, and walk independently between locations.
Toileting includes the ability to get on and off the toilet.
Continence differs slightly from toileting, in that it includes the ability to control one’s bladder and bowels.
If you struggle to perform two or more of these ADLs without assistance, on a consistent basis, you may qualify to receive your LTC benefits.
Why were my Long-Term Care benefits denied?
Even if you meet the criteria to receive LTC benefits, your claim may be denied. It is in the insurance company’s financial interest to deny these benefits, because they can cost the insurance company significant money. The insurance company may cite some of the following reasons as the basis for your LTC benefit denial; many of these reasons may be unsubstantiated or inaccurate.
Your insurer may:
- Dispute that you actually need assistance with the ADLs that you cited.
- Dispute that you have a cognitive impairment severe enough to warrant LTC benefits.
- Allege that you didn’t pay your premiums, either on time or at all, which could disqualify you from receiving your benefits.
- Assert that the company providing your care services isn’t “eligible” under your plan.
- Cite a “gatekeeper provision”, which is seen more often in older LTC policies. Gatekeeper provisions require you to have had a hospital stay, nursing home confinement, or both before your claim will be paid.
- Claim that your medical condition has either improved, is not severe enough, or is excluded entirely under your policy.
- Procure conflicting medical opinions regarding your medical condition or disability.
- Conduct surveillance on your claim and use surveillance or social media posts as a misleading reason to deny benefits.
Answers to Common Long-Term Care Benefits Questions
what is long term care insurance?
Long-term care insurance (LTC) is a type of insurance coverage that will help pay for the care that you require in the event that you become disabled. Types of care that may be covered by an LTC policy may include:
- Nursing home care
- Assisted living
- Adult day care services
- Home health care
- Home modifications
- Care coordination services
There two main types of LTC policies, and sometimes they are a blend of both: indemnity and reimbursement. Indemnity policies pay you a set amount as a daily benefit, regardless of the actual cost of your case. Indemnity policies are similar to cash benefit policies, which also pay a particular benefit amount per day. Reimbursement policies pay up to a certain daily benefit limit depending on the cost of your care. If your care costs more than that daily benefit amount, you will be responsible for paying for the additional cost of your care. Knowing what type of LTC policy you have is an essential component of understanding your benefits, and we can review your LTC policy to help you understand your coverage.
what does a long term care policy not cover?
Why do long-term disability benefits claims get denied?
LTC benefits are often denied in bad faith due to the cost to insurance companies. Your LTC insurer may cite a number of reasons when denying your claim, but it is important to remember that they ultimately have a vested financial interest in denying your benefits.
When someone files an LTC claim, the insurance company must set aside the monetary amount that the claim is worth in reserve. If the claim is denied, the insurance company can release that reserve, bolstering their profits. According to Advocate Magazine, the amount of reserves for LTC claims is expected to increase to $15 billion over the next 15 years, which means that insurance companies will be especially eager to release those reserves by denying LTC claims.
If your LTC claim has been denied, contact the experienced attorneys at Ronstadt Law for a free consultation.
Are long term care premiums tax deductible?
What should I do if my Long-Term Care benefits are denied?
If your LTC benefits are denied for any reason, you should seek legal counsel.
Don’t give up on pursuing the benefits that you deserve.
You paid the premiums for the policy in the unfortunate event you ever needed it. The laws surrounding LTC policies and the coverage itself can be complicated – contact the experienced Arizona disability attorneys at Ronstadt Law.
Marc M. | 2021
The perfect choice! I’m so pleased that I choose Erin and her team to represent me. She had everything I was looking for in a disability attorney: professional, knowledgeable, respectful, caring and passionate about her work. She was always on point and nothing got passed her! Her team is equally qualified and efficient! 100% no reservations I would recommend her and her team!
Scott D. | Flagstaff – 2018
Erin Ronstadt was my LTD attorney. She is very knowledgeable on Employee Plans and the ERISA law. She was very easy to work with, compassionate and understanding. She kept me informed on the status of my case and kept me updated on the next steps. She did an awesome job winning my case and got me much more than expected.
Marshall S. | Tempe – 2018
Erin Ronstadt is a competent and caring attorney and we are pleased with our settlement. We felt very comfortable working with Erin and her assistant, we would not hesitate to work with her again.
Daryl S. | Sedona – 2018
Unfortunately life happens and sometimes we have to hire an attorney. Erin and her staff have made an uncomfortable situation more tolerable. The entire staff has worked hard on our behalf and made us feel included and heard along the way.
Michelle – 2019
“Erin and her team were the shining light in this otherwise extremely long and difficult experience.”
Robert I. | 2021
I’ve worked with hundreds of attorneys over the past 30 years and Erin and her team (Merry) are truly excellent. Professional, knowledgable, responsive and so very pleasant.
Ray M. | Finisterre – 2017
I had a great experience with this firm. Everyone here is extremely courteous, kind, and professional. My attorney, Erin Ronstadt is very knowledgeable and truly cares about her clients. She has done a terrific job with my case and I would highly recommend her for anyone that needs representation!
Erika B. | Mesa – 2017
I highly recommend Erin Ronstadt if you need help with your disability case. Erin was very knowledgeable and compassionate. I knew I was in good hands after our consultation. Her advice led to a successful outcome for us. If there were more than 5 stars I would give them.
Bob S. | Surprise – 2014
Did a great job on my case——-we WON in court!
Our long-term care insurance lawyers know how to fight insurance companies.
Case evaluations are 100% free and you are under no obligation to hire our law firm. We will vigorously represent you and not back down to insurance companies.