Our law office is seeing a new trend: long-term care policies are giving their policy holders the “run-around.” Many seniors have long-term care insurance that they purchased years ago. They paid their premiums faithfully, and now due to advanced age, dementia, illness, and other needs, they make a claim for benefits. In response, the insurance company denies the claim. These denials are often unfair and illegal. Unfortunately, the senior does not know their rights, their remedies, or how to fight the insurance company.
Typical reasons for these insurance denials are often not valid – the companies do not want to pay claims. Many policies were written years and years ago, and are simply not profitable for the insurance company. They deny claims without investigation, without getting all the facts, and without reading their own policies.
Many denials are based upon such crazy arguments as the “caregiver is not licensed,” yet, there is no licensing available in California for caregivers. Or, the insurance company often claims that assisted living facilities are not covered by the terms of the policy. Yet, a close reading of the policy shows that the facilities are covered, and the claim for benefits should be allowed. Or, the insurance company argues about cognitive function, activities of daily living, lapsed policies, or other areas – often without basis and to the detriment of the senior.
Many seniors have saved their marketing materials from years ago when they purchased the policy. They can show that the agent made promises to sell the policy, but now the insurance company is denying the claims that were supposed to be covered. Certain companies have a pattern and practice of denying legitimate claims, while other companies have a better track record of honoring their policies.
If you become aware of an improper claim denial or an insured being treated unfairly, please take action. Seniors should pursue these insurance companies, and not take these denials lightly. The denials are often wrong, and made improperly and unlawfully. Protect your rights, your assets, and those you love.
For more information, please call the Law Office of Jane M. McNamara at 661-287-3260. You can also visit www.janemcnamara.com or www.vabenefits4seniors.com.