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A Record Of Results For Long-Term Care Insurance (LTC) Claims

Long-term care (LTC) insurance policies vary widely and many legal issues have yet to be resolved by the courts. As your long term care insurance lawyer can tell you, ailing, aged or incapacitated individuals and their families are devastated every day when their insurance carriers tell them that necessary long term care benefits are not covered by the expensive long term care policy they purchased. And these are the policies they have been paying heavy premiums for years and years.

A major reason for these insurance denials is that insurers are relying on the “wimp” factor. This is a common malady with insureds. However, it is more likely to be a factor as people grow older and become more infirm. Many legitimate claims are never paid because insureds choose not to challenge a denial of benefits by an insurance company. Insurance companies are happy to take advantage of policyholders who take “no” for an answer. This is the case even when the denial of benefits is wrongful. The lesson is clear: do not accept “no” without challenging it.

Photo of Attorney Michael QuiatExperienced Long-Term Care (LTC) Lawyer in NYC and NJ

Uscher, Quiat, Uscher & Russo, P.C.. are leaders in this burgeoning field of law. As long-term care lawyers in New York and New Jersey, we offer more than 40 years of experience in litigation and insurance law. If you have an inkling that you or a family member is being denied benefits when your policy calls for them, contact us immediately.

Long-Term Care Insurance

Long-term care (LTC) insurance plans were devised to assure high quality care when a person is incapacitated and needs assistance with Activities of Daily Living (ADL’s). Policyholders and those thinking of buying an LTC policy should be sure that the terms of their policies permit them to choose an inpatient facility or an at-home care plan so as to avoid state-run nursing homes.

More information about long-term care insurance claims is available. Read about the the basics of LTC insurance

Proper long-term care policies also eliminate the need to spend down personal assets so as to qualify for Medicaid. This is because a good LTC policy largely negates the shame and indignity of having to “qualify” for Medicaid.

Most policies cover 24-hour care and other needs:

  • Nursing homes
  • Assisted living facilities
  • Home health aides Medical equipment

But, these policies also include exclusions and limitations that can derail a claim before it even starts. For more help in ascertaining your needs and how to time your purchase of an LTC policy take a look at this article.

Why Insurers Sometimes Deny Claims

Often the fine print in your LTC policy or the way the insurer interprets the policy language results in a denial of benefits. For instance, some policies will reimburse a family member who is willing to provide home care, but many do not. This forces families to turn over care of their loved one to strangers. Or, the insurer deny payment for medical necessities, such as home appliances, wheelchairs, assisted transportation, lifts or home improvements to meet certain medical requirements.

Many times the insurer hangs its denial on a report provided by the policyholder’s doctor. Busy physicians don’t always take the time to fully and completely explain a patient’s condition. When that happens, an experienced LTC lawyer sees to it that the doctor’s report fully describes the policyholder’s medical status relative to the need for long-term care.

When your claim is denied, Uscher, Quiat, Uscher & Russo, P.C., will examine the specifics of your LTC policy and advise you on the best course of action. Some insurers negotiate. Other insurance companies take a hard stand, necessitating litigation. Our attorneys are veterans at trial. We have successfully represented clients against most major insurance companies.

To Ensure the Best Long-Term Care for Your Loved One, Make Arrangements With a Long-Term Care Insurance Lawyer in NJ and NYC

We have many years of experience in the long-term care insurance laws of New Jersey and New York. Our long term disability lawyer can review an LTC policy if you are planning for care. We can also represent you if your claim has been denied. Call 201-781-5645 or send an email for help today.