Long Term Care

What is long-term care insurance?

Unlike traditional health insurance, long-term care insurance is designed to cover long-term services and supports, including personal and custodial care. These types of policies also reimburse individuals for services they need to assist themselves, and can cover services such as dressing, bathing or eating.

Additionally, most long-term care policies are comprehensive, meaning they allow you to use your daily benefits in a variety of settings. Examples of these settings include your home, an adult day service center, or an assisted living facility, among others.

Unfortunately, when many seniors are finally ready to benefit from their policies, they often have difficulty convincing their insurers to approve their claim. As such, here is what to consider before filing your long-term care insurance claim.

How do you qualify for long-term insurance care benefits?

In order to qualify for benefits, claimants must typically prove that they either have a cognitive impairment or need help with two or more activities of daily living (ADLs). The most common examples of ADLs include bathing, dressing, eating, transferring and toileting.

One of the most effective ways for a claimant to document these impairments is by seeing his or her doctor. By doing so, their doctor can confirm in writing which ADLs a claimant is unable to perform, and it will further reflect the type of care and assistance needed under their policy.

Lastly, before your claim is ultimately approved, your insurer will likely conduct an in-person assessment of your condition to corroborate your reported disabilities. It is important not to minimalize your ailments or injuries during this assessment, as this will make it much more likely for your insurer to deny your claim. If you are approved following this assessment, your care manager from the insurance company will outline a Plan of Care detailing the benefits for which you are eligible.

When will your benefits be available?

Most long-term care polices have an elimination period similar to a deductible. In sum, this is a period of time that you must pay for your care before your benefits are paid. Elimination periods typically range from 30 to 120 days and some policies even require proof that you paid for the care services during this time frame before your benefits will be paid for by your insurer.

In general, the shorter your elimination period is, the higher your premium will be.

How can an attorney help?

Unfortunately, many senior citizens face difficult financial burdens when their long-term care claims are denied and they are forced to pay for their own services out of pocket. Given that insurance companies often attempt to reduce benefit payments to their holders, they can make the process of obtaining these benefits very difficult.

For example, they may overwhelm and confuse their holders with large volumes of paperwork or make it difficult to speak with the same benefits administrator. As a result, many of these policy holders may choose to give up on their claim.

If you or someone you know is having difficulty with a long-term care insurance company, the skilled and compassionate attorneys at Murray Law Office can help you sort out your insurance claim. For a free consultation with an attorney, visit our website or call us at (617) 720-4411.