States Implement New Long-Term Care Legislation

This new legislation is a step in the right direction and will help protect consumers against long-term care insurance providers.

November 28, 2012

Problems with long-term care insurance claims are not new to consumers. Many have found that insurance companies are slow to pay out benefits and frequently deny their long-term care claims all together. To protect consumers against wrongful claims denials, states are passing new regulations to improve the long-term care industry.

Oregon is one of the states that's taken measures to protect their citizens. New legislation allows consumers the right to get an undisputed claim paid within 30 days. They also have the right to an appeals process if they feel their claim has been wrongfully denied.

"This is a serious improvement from the way it was before. It used to be that the only way an individual in Oregon could appeal a long-term care decision was through the courts, a long and costly process for a person with long-term care needs. Now, consumers can turn to their state department of insurance," says Frank N. Darras, America's top long-term care lawyer.

This problem isn't confined to Oregon, but widespread across the United States. The National Association of Insurance Commissioners has developed model legislation for states to pass and follow in Oregon's footsteps. However, many long-term care insurance companies continue to argue that benefits are outlined in consumer contracts and fear this legislation will lead to a slippery slope.

"It's common for individuals to skip over the fine print before purchasing a long-term care insurance policy. Sometimes denials are wrongful on the part of the insurance company, but more after they are the result of an uninformed consumer. It's extremely important to understand what your policy does and does not cover before signing anything," says Darras.

Not all care facilities are covered under long-term care insurance policies, specifically if the facility does not meet credentialing requirements to be licensed by the state. In-home care is also not usually covered by a long-term care policy unless that option has been added on by the policyholder.

"In addition to knowing exactly what is and isn't covered under your policy, be sure to take extreme care when filing a claim. Submitting incomplete or incorrect paperwork is another common cause of a claims denial or delay in payment. If you are unsure about your rights, consult a top long-term care lawyer. Lawyers who have experience dealing with long-term care claims denials will help you avoid fatal claim mistakes," says Darras.

Wrongful claims denials do happen and it's the role of state departments of insurance to step in when they do. This new legislation is a step in the right direction and will help protect consumers against long-term care insurance providers.

"This new legislation makes the appeals process easier and less costly for consumers. It is a welcome change in this industry. However, if you have taken these measures and still haven't received the benefits you are entitled to, it might be time to consult a top insurance lawyer," says Darras.