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Long Term Care Insurance Claims

What is Long-Term Care Insurance?

Long-term care insurance (or long-term disability insurance) is an insurance policy that provides the policyholder with money to supplement the income lost as a result of a physical disability. These can typically cover losses from illness, injuries, and/or accidents. 

On average, an individual with a long term disability will be out of work for upwards of 2 years. 

This can wreak havoc on individuals and families who rely on that money to live and survive. A long-term disability policy does not cover work-related injuries. These are typically covered under worker’s compensation insurance through the company. 

How does it Work?

Long-term care insurance policies work like any other insurance policy. The policy owner is required to make a claim for benefits. If the insurance company denies the claim for benefits, they must provide a written explanation for the denial. Individuals who have been denied benefits have the right to appeal that decision. 

Insurance companies that offer long-term care policies have their own definition of what might constitute a disability. It is important to understand the terms set forth in your policy completely. If you need help interpreting the policy, an experienced attorney can assist you in this process.

Insurance Companies Like to Deny Claims

Insurance companies are in the business of making money. That’s the main difference between long-term care policies and benefits available through the Social Security Administration’s Long Term Disability Insurance (SSDI), for example. 

The fewer benefits the insurance companies have to pay out, the more profitable their company becomes. It’s simple math, really. The problem is that policyholders are conscientious about paying their premiums and expect that their insurance company will follow through when the insurance is needed. Unfortunately, that is all-too-often untrue. Many insurance companies are more interested in their own profit margin than ensuring their customers get the benefits they deserve. 

This is where the services of a professional law firm can help you fight for the benefits you deserve. 

Limitations of Long-Term Care Insurance

It is not profitable for insurance companies to pay benefits indefinitely. That is why most long-term disability policies have a limit of one to two years for the policyholder to collect benefits. This is referred to as the own occupation period of disability as defined in the individual’s policy. 

If an individual wants to receive benefits beyond this period of time, they have to prove that they are permanently unable to work. These policies can be purchased individually, or they can be offered as part of an employer’s insurance package. 

When the benefits are part of the employer’s package, those benefits fall under the Employee Retirement Income Security Act (ERISA). While this might seem relatively harmless, it actually is beneficial to the insurance companies. All lawsuits governed by ERISA must be filed in federal court. 

If someone has a private insurance policy, these are regulated by the state in which the policyholder lives. The difference between state and federal cases is that policyholders are more apt to collect damages and be reimbursed for attorney’s fees at the state level. 

Why an Attorney is Necessary for Self-Employed Individuals

If you are self-employed, you need to contact an attorney before you file a claim for disability. The reason for this is that insurance companies tend to use the reasoning that the policyholder is not actually unable to work; they are just bad at running their business. 

These accusations can be not only frustrating but can be difficult to defend against. With an experienced attorney on your side, they will help you to complete a thorough application, which will be much more difficult for the insurance company to dispute. A professional attorney understands all the small details and tactics insurance companies try to use to keep policy owners from collecting benefits. What may seem like a valid reason for denying a claim could be the exact opposite. An experienced attorney can help you with the appeal if your claim is denied and litigate your case in court if necessary. 

Contact Insurance Claim HQ Today for Your Long-Term Insurance Claim Needs

We are a professional team of insurance claim attorneys with a wealth of experience dealing with insurance companies. We have an excellent record of getting our clients the compensation they deserve and all the benefits they worked so hard to purchase. 

If you have had a claim denied or need help filing your claim, contact us today for your free case evaluation. 

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(844) 587-8395

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