Assisting In All Long-Term Care Insurance Matters

Over the last several years, seniors and/or their families have contacted me about not getting the benefits and coverage that they are entitled to through their long-term care insurance. Claims have been denied or payments have been delayed.

In some instances, this is a result of the senior and/or the family misunderstanding the policy and its coverage provisions.

In other cases, however, the denial of coverage is wrong. This may be because the insurance carriers are taking a very strict position with respect to their interpretation of coverage with respect to the policy.

At other times, the insurance company’s position on denial of coverage may be wrong, primarily as a result of:

1. Not receiving sufficient information and/or not interpreting the claim and supporting information appropriately
2. Interpreting and applying the terms of the policy incorrectly to the individual facts of the situation
3. On some occasions, not appropriately processing the information and/or claim paperwork that is given to them

The bottom line on all of this is that a denial or claim rejection by an insurance company that you think is wrong should not simply be accepted as being correct without there being a follow-up by the insured or their family, and then obtaining an exact explanation that the senior and/or their family finds acceptable as to why the insurance company acted as it did.

Potential Solutions and Outcomes For These Cases

In various circumstances in which I have been involved over the last several years, there were situations where the insurance companies have:

1. Reversed their initial decision and provided full coverage
2. Provided at least partial coverage
3. Amended their determination as to the start and extent of coverage

Note too that there may be the ability to reopen and reverse a prior denial of coverage even if it occurred in the past.

The bottom line is that long-term care insurance premiums have been paid, in most cases for many years, against just the eventuality that many seniors and their families are now facing, and they should be entitled to the full coverage afforded by their policies.

The insurance company is not necessarily going to do the work of the senior who is insured and/or the insured’s family, nor will it do the work of the nursing home and the health care professionals/doctors who have to provide the information.

Schedule A Free Consultation With A Pennsylvania Lawyer

Intervention by an attorney can help in many instances. At times, litigation may be the answer. Accordingly, if you are experiencing these types of difficulties with obtaining coverage, please contact me online or call 412-847-5558 so that we can determine if I can be of any service in reviewing your particular situation.

I offer free initial consultations. My office is open from 9 a.m. to 5 p.m., with early morning, evening and weekend appointments available.

My office is on McKnight Road a few miles north of the Ross Park Mall in the North Hills section of Pittsburgh. I am also willing to travel to the homes of clients who are unable to come to my office.