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Consider these steps when filing a claim for long-term care benefits

We’ve explored why insurers are reluctant to pay claims and the questionable tactics they use to justify denials.

Our intent was to embolden policyholders, but it’s possible that you now have some uncertainty about your coverage. It’s important to remember that not all insurers will resort to previously discussed strategies that cause denied claims. You can improve your chances of a successful claim by following the tips we outline below.

Before you file a claim

Seniors filing claims under long-term care (LTC) policies should consider authorizing an adult child to act on their behalf. This can prove to be helpful should policy disputes arise, because it effectively leverages the power of two people. Insurers should have adult children listed as third-party designees. Doing this simple step ensures that policyholders and their children receive copies of important communications, including lapse notices.

When you file a claim

Read carefully through the LTC policy first to ensure your claim is characterized properly. When preparing the claim, experts suggest providing as much evidence as possible.

While your claim is being processed

An adult child should be present to serve as an advocate and help clarify medical records if an insurer wants to perform an in-home assessment. For example, older parents may have trouble remembering or become too proud to discuss certain issues.

If your claim is denied

Experts advise against attempting to sort the matter out via phone as it leaves room for ambiguity without the benefit of creating a paper trail.

If the insurer refuses to cooperate, the insured may always consider consulting with an attorney.

Source: Forbes, “How long-term care insurers deny benefits,” Richard Eisenberg, March 21, 2014

DarrasLaw is Americas' most honored and decorated disability litigation firm in the country. Mr. Darras has seen more, evaluated more, litigated more, and resolved more individual and group long term disability and long-term care cases than any other lawyer in the United States.

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