News & Resources

Keeping you informed is part of our mission.

Payment of long-term care policies often delayed or denied

Sat Jun 7th, 2014 on     Long-Term Disability,    

Many long-term-care insurance policies do pay out. However, according to attorneys and consumer advocates there are a number of circumstances when individuals will spend a substantial amount of time trying to collect upon these policies.

It’s important for policyholders to understand what these policies cover to begin with. There may be language and a number of provisions in policies that will prevent individuals from collecting upon them when a claim is made.

It’s important to know what the deductible period is when it comes to policies. For example, there may be a listing of certain days that one must wait before the policy will pay for services. The policy may use “calendar days” for determining when they will start paying upon a claim or it may use “service days,” which could result in a much longer wait for the payment. In any event, it’s advisable to file a claim as early as possible.

Another obstacle is demonstrating that an actual disability exists. The claimant may need to prove that they need assistance with certain activities or actually be able to prove that impairment exists. In any event it’s important to have medical documentation in order.

Finally, it’s important to understand what kind of care will actually be covered under the policy. For example, a policy may only pay for a licensed caregiver and not a professional that is only providing personal care. 

Unfortunately the limitations that insurance companies may place on payments can come from language buried deep in the insurance policy. Individuals that hold onto long-term disability and care policies may discover that the company they have paid substantial premiums for may not honor a policy for a variety of reasons. The denial may also come at the very worst time.

In such circumstances the policy holder may have to file an action against the insurance company to resolve such a matter. There are attorneys that can help provide one’s legal options concerning such matters.

Source: Sun Sentinel, “Avoid traps that could block payment of a long-term care insurance claim,” Susan B. Garland, May 12, 2014

Listed in Best Lawyers
Best Law Firms - Insurance Law
Super Lawyers
Florida Legal Elite
Top Lawyer - South Florida Legal Guide
Association of Corporate Counsel - South Florida Chapter
Back to top