Dealing with the Denial of Your Long-Term Care Insurance Claim

With the current cost of long-term care services, may people choose to purchase long-term care (LTC) insurance policies to help subsidize these costs. While LTC policies are integral to many life care plans, LTC claims are often denied, leaving the insured in the difficult position of paying significant out-of-pocket expenses that should have been covered by the LTC policy.

When LTC claims are denied, the insurer has an obligation to specify the exact basis for its denial. Typically, this is done in what is called a denial letter. If the specific reason for denial is not given, you should immediately seek the basis for the denial from the insurer.

Once you know the basis for the denial, many policies allow the insured to provide the insurer with additional information to support the claim. If you have additional information that you believe supports the LTC claim, you may want to provide the insurer with this information.

Most policies also provide for an internal appeal of the denial. The time by which you must appeal a denial of LTC benefits is usually found in the policy; however, if it is not, you should clarify the appeal time with the representative who sent the denial letter. An appeal is typically a written statement outlining the basis for the claim and the LTC policy covers the claim.

Once all appeals allowed under the policy have been exhausted and the insurer continues to deny benefits, you may file a lawsuit against the LTC insurer for breaching its LTC insurance contract.

Strategies for dealing with a denial of LTC benefits vary depending on the basis for the denial, but you do not have to accept a denial of LTC benefits. If you believe that benefits should be paid under the policy, you should not let the insurer simply deny benefits. Doing so could have a significant negative impact, both financially and emotionally.

Isaac I. Tyroler
Associate Attorney
Maser Amundson, P.A.

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