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How Do I Get My Long-Term Care Insurance Claim Paid?

Long-term care (LTC) insurance can mean the difference between struggling and living comfortably with an illness, condition, or permanent disability. LTC insurance covers home care, assisted living, nursing home facilities, adult daycare, and hospice care. LTC insurance for home care typically pays for a live-in caregiver, housekeeper, companion, therapist, or private-duty nurse. Trouble getting an LTC insurance claim paid can lead to harmful delays in personal and medical care. Here’s what you need to know about getting your LTC insurance claim paid.

About LTC Insurance Claims

Long-term care insurance can be the ideal solution for people in need of assistance who do not want to rely on their family members. Asking family for long-term care can be uncomfortable, and make a disabled person feel like a burden. LTC insurance is an affordable, viable way to get the care a person with a disability needs from experienced professionals. To qualify for LTC insurance, a person must prove an inability to perform at least two activities of daily living without hands-on or standby assistance. Activities of daily living include eating, bathing, dressing, toileting, and walking. Inability to perform two of these activities alone qualifies most people for LTC insurance benefits.

A physician must confirm your inability to perform activities of daily living, and recommend long-term care with an appropriate provider. Your physician’s plan of care should align with the type of care your insurance policy covers. When you submit your LTC insurance claim, include as much detail and evidence of your disabilities as possible. Feel free to include information beyond what the claim form asks for or allows. Include your certification from your physician stating that you need the treatment you are requesting. Submit your claim to your insurance company and wait for a response.

Your insurance company may assess your claim over the phone or in person, to verify your need for care. Note that an insurer cannot deny your claim without an in-person assessment by a licensed healthcare provider. A good faith insurance company typically will not delay your LTC insurance claim payment. You should expect to see your payment in a timely manner, per your insurance policy’s timeline. If you are having trouble getting your insurer to pay your LTC insurance claim, you may need help from a bad faith attorney.

Bad Faith Insurance Company Claims

A bad faith insurance company will take advantage of policyholders’ lack of knowledge and vulnerabilities to avoid making a payment. Long-term care insurers are aware that their policyholders are typically elderly, infirm, or cognitively impaired. Unfortunately, this leads to many bad faith incidents for LTC insurance claims. An LTC insurer may interpret the language of your policy to serve its interests and not your interests, refusing to give you the benefits you assumed you were eligible for upon signing the agreement. Bad faith insurance companies may also deny ever receiving necessary documentation from you, such as your doctor’s certification of your infirmity.

Insurance companies may also use biased physicians to help them justify denying your legitimate claim. If your insurer ignored or failed to advise you about the nature of your benefits and claim payment, this is also a sign of bad faith. If you are struggling to get your insurer to pay your LTC insurance claim, you may be able to take the insurer to court in a bad faith insurance company claim. Battling an insurance company can be difficult, but it’s worth it if you obtain the long-term care insurance you or a loved one needs to live comfortably. Seek help from an experienced bad faith insurance company lawyer if you need help with an LTC insurance claim payment.