ATTORNEY NEWSLETTER
Long-Term Care Insurance Claims
A recent study indicates that couples retiring this year will need $280,000 to cover health care and medical expenses over the course of their retirement. That amount excludes nursing home costs. The increase reflects both rising health care costs and the fact that people are living longer and the number of years for which care will predictably be needed are mounting. Long-Term Care Insurance has always been sold by agents to help you pay for care when, later in life, you are unable to take care of yourself. Insureds trusted the policies would cover the costs of assisted living care, skilled nursing facilities, and in-home care among other coverages, but in reality, the policy may not live up to the promises.
Industry watchers report some carriers are increasingly denying claims in order to stem the underwriting losses being generated by increased claim volume. Some of the coverage denials may in fact be bad faith denials by the carriers. If you live in San Francisco or elsewhere in California and believe your long- term care claim has been denied in bad faith, call Evans Law Firm Inc. today at 415-441-8669 for a free review of your policy and possible bad faith claim denials. We handle cases in California only.
Understand Your Coverage Terms
Long-term care policyholders and their families spend months, and sometimes years, struggling to persuade insurers to pay the bills submitted as claims. It’s important for you to understand what your policy covers and what documentation you need to substantiate your claims. Below are a few tips on the claims process. If you believe your claim has been unfairly denied, call the long-term care insurance attorneys at Evans Law Firm today.
Here are a few pointers to keep in mind when submitting claims:
- Determine when the clock starts ticking on your claim. Policies typically include a deductible, known as an elimination period, of 20, 60 or 90 days. Some insurers differ on how they count these days, whether they are calendar days or service days, for example.
- Pass the disability test. Most policies require that the claimant be “cognitively impaired” or need help performing two or three “activities of daily living,” such as bathing or eating. You will need documentation from your physician on this threshold requirement so ask for it as early as you can from your doctor.
- Check the caregiver requirements. Many policies only pay for licensed caregivers as a neighbor, friend or family member acting as an aide may not be covered. You don’t want to find out that the caregiver you’ve hired – and paid – will not be covered.
- Keep a log of all communications from the insurer. Follow up all phone calls with an email of fax confirming what you were told. If the insurer continues to drag its feet or deny a claim, consider hiring counsel such as the attorneys at Evans Law Firm who specialize in filing “bad faith” claims against insurance companies.
Some of the leading providers of long-term care insurance in California are listed below. We do not mean to suggest in any way that these carriers have done anything wrong or denied claims in bad faith. Rather, the list is provided solely for our readers’ reference.
- AXA Equitable Life Insurance Company
- Bankers Life and Casualty Insurance Company
- CNA Financial Corporation
- Colonial Penn Life Insurance Company
- Guardian Life Insurance Company
- John Hancock Life Insurance Company
- Lincoln National Life Insurance Company
- MassMutual/Massachusetts Life Insurance Company
- Minnesota Mutual Life Insurance Company
- Mutual of Omaha Life Insurance Company
- Nationwide Mutual Life Insurance Company
- New York Life Insurance Company
- Northwestern Mutual Life Insurance Company
- OneAmerica/American United Life Insurance Company (AUL)
- Pacific Life Insurance Company
- State Farm Life Insurance Company
- Transamerica Life Insurance Company
Contact Us
If you believe that you or a loved one has been the victim of a bad faith claim under a long-term care insurance policy, contact Ingrid Evans and the other California and San Francisco financial elder abuse and long-term care insurance attorneys at the Evans Law Firm at (415) 441-8669, or online at www.evanslaw.com. We can help guide your case through trial, or toward an equitable settlement. We handle cases involving physical and financial elder abuse, qui tam and whistleblower law, nursing home abuse, whole life insurance and universal life insurance, and indexed, variable, and fixed annuities.
