Long Term Care Insurance Litigation
Long Term Care Insurance (LTC) is part of responsible financial planning for many. You purchase insurance and pay premiums for years to protect your savings in the event that you or a loved one require expensive medical care.
Insurance companies have convinced us that we must have such protection with increased life expectancy the associated risks of Alzheimer’s, stroke, Parkinson’s and other disabling conditions. However, insurers do not always hold up their end of the bargain when it comes time to pay. When these benefits are wrongfully denied or terminated, we have the experience and expertise to even the playing field, even if litigation is necessary to resolve the dispute.
Employer Provided LTC Insurance
Similar to disability policies, if LTC insurance is employer-provided and therefore governed by ERISA, an individual must first file an appeal directly to the insurance company. Our firm handles these appeals on a national basis. If the appeal is denied, we will file a lawsuit on your behalf, normally in federal court. Even if the policy was purchased privately and is not ERISA governed, the companies will often consider an internal appeal in lieu of filing in Court. We can assist you during any appeal.
Why do I need a lawyer for an appeal?
The vast majority of appeals are denied. Think about it, you are appealing to the company that denied your claim or terminated your benefits. The only way to convince the insurer to reverse their denial is to convince them that you will win when you go to Court. We place a lot of attention and focus on the appeals process. This is due to the fact that we understand how important it is to any given case because:
- It greatly increases chances that the insurance company will reverse their denial and grant benefits; and
- If the case ultimately goes to court, the court will look heavily upon evidence submitted to the insurance company during the administrative appeals process. So it is to your advantage to submit as much relevant information as possible for the record.
COMMON ISSUES IN LONG TERM CARE INSURANCE DENIALS/TERMINATIONS
The following are common issues that arise in LTC disputes with insurance companies:
- Whether you qualify for benefits and how much
- Whether your benefits are limited or excluded by policy language
- Your right to choose your care and providers
- Whether your LTC policy covers home health, transportation, etc.
- Whether your LTC policy covers prescribed treatment or equipment
- Whether you are entitled to round-the-clock care
- Whether you can choose to remain in your home vs. assisted living
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