Long-Term Care Insurance Claims
Long-Term Care Insurance Claims in Kansas or Missouri
Long-term care insurance is designed to provide financial protection when you or a loved one needs assistance with daily living due to illness, injury, or cognitive decline. After paying premiums for years—sometimes decades—you expect your insurance company to honor its promises.
Unfortunately, many policyholders discover that obtaining benefits is far more difficult than they anticipated.
If your long-term care insurance claim has been denied, delayed, terminated, or underpaid, our firm can help. We represent policyholders and their families in disputes with long-term care insurance companies and work to obtain the benefits our clients are entitled to receive.
What Is Long-Term Care Insurance?
Long-term care insurance helps pay for services that are generally not covered by traditional health insurance or Medicare. Depending on the policy, benefits may cover:
- Assisted living facilities
- Nursing homes
- Memory care facilities
- In-home caregivers
- Adult day care
- Hospice services
- Home health aides
- Care coordination services
Coverage depends on the specific language of your policy, including eligibility requirements, waiting periods, benefit limits, and exclusions.
Why Are Long-Term Care Claims Denied?
Insurance companies deny claims for many reasons. Some denials are legitimate, but many result from overly restrictive interpretations of the policy or incomplete claim evaluations.
Common reasons for denial include:
- Alleging the insured is not unable to perform enough Activities of Daily Living (ADLs)
- Claiming the insured does not have a qualifying cognitive impairment
- Disputing medical necessity
- Arguing that documentation is insufficient
- Claiming the elimination (waiting) period has not been satisfied
- Disputing the type or level of care received
- Alleging care providers or facilities do not meet policy requirements
- Interpreting policy language in the insurer’s favor
- Terminating benefits after they have already been approved
In many cases, these decisions can be challenged.
Understanding Activities of Daily Living (ADLs)
Many long-term care policies become payable when a person cannot independently perform a certain number of Activities of Daily Living.
These commonly include:
- Bathing
- Dressing
- Eating
- Toileting
- Transferring (moving in and out of bed or chairs)
- Continence
Insurance companies frequently rely on their own assessments to determine whether these limitations exist. We carefully review medical records, physician opinions, caregiver documentation, and other evidence to challenge inaccurate assessments.
Cognitive Impairment Claims
Many policies also provide benefits for individuals suffering from cognitive impairment, including conditions such as dementia or Alzheimer’s disease.
Insurance companies may improperly minimize memory deficits or claim an individual remains sufficiently independent despite significant safety concerns.
Our firm works with treating physicians, neuropsychologists, family members, and caregivers to develop evidence supporting eligibility for benefits.
We Handle Every Stage of the Claim
Whether you are just beginning the claims process or have already received a denial, we can assist with:
- Reviewing your policy
- Explaining your coverage
- Preparing or supplementing claim submissions
- Appealing claim denials
- Responding to requests for additional documentation
- Challenging benefit terminations
- Negotiating with insurance companies
- Filing litigation when necessary
Our goal is to maximize the likelihood that you receive every benefit available under your policy.
Insurance Companies We Commonly See
Our clients have purchased long-term care insurance policies from many different insurers, including:
- Genworth
- Bankers Life
- Mutual of Omaha
- New York Life
- John Hancock
- Northwestern Mutual
- Brighthouse Financial
- Thrivent
- MassMutual
- State Farm
- Silac
- Transamerica
Regardless of the insurance company involved, every claim should be evaluated according to the terms of the policy and the applicable law.
Why Legal Representation Matters
Long-term care insurance policies are often lengthy and complex. Insurance companies have experienced claims professionals and legal teams evaluating every submission.
Having an attorney involved can help ensure:
- The policy is interpreted correctly.
- Medical evidence is fully developed.
- Deadlines are met.
- Appeals are properly presented.
- The insurance company is held accountable when it fails to honor its contractual obligations.
Many clients contact us after months of frustration trying to navigate the claims process on their own. We work to relieve that burden so families can focus on caring for their loved one.
Contact Our Firm
If your long-term care insurance claim has been denied, delayed, reduced, or terminated, you do not have to face the insurance company alone.
We represent policyholders seeking the benefits they paid for and deserve. Contact us today to schedule a consultation and learn how we may be able to help you recover the long-term care insurance benefits available under your policy.