Fort Lauderdale Long-Term Care Insurance Attorney
Accessible and Compassionate Legal Guidance in Delray and Throughout South Florida
Long-term care is extremely expensive and will not be covered by most government benefit programs. Investing in a long-term care insurance policy allows you to prepare for a future where you are no longer able to care for yourself. Unfortunately, some unscrupulous insurers will do everything possible to avoid paying benefits to vulnerable policyholders who urgently need comprehensive, ongoing care.
Our Fort Lauderdale long-term care insurance lawyer at Martin J. Sperry, P.A. can help you and your family fight wrongfully denied claims. Our firm has over 45 years of legal experience and in that time has recovered millions of dollars for our clients. We understand the frustration you are experiencing and will work one-on-one with you to explore every possible legal option.
How Life Insurance Policies Work
While it can be less than pleasant to think about, the reality is you may not be able to take care of yourself forever. Disabilities and debilitating medical conditions can result in your needing intensive and ongoing medical care. Long-term care insurance policies cover the often-exorbitant expenses associated with assisted living facilities and ongoing at-home care. This includes stay-at-home caregivers, nursing homes, and adult daycares.
Long-term care insurance policies must be negotiated and purchased in advance of the emergence of any chronic medical conditions or disabilities. In other words, you cannot typically purchase long-term care insurance if you know for sure that you will soon need long-term care. Failing to disclose a known medical condition can void your coverage. Most policyholders purchase coverage in their 50s and 60s.
Why Long-Term Care Insurance Claims Are Denied
Because claimants of long-term care insurance policies are elderly and disabled, some insurance companies will operate in bad faith and wrongfully deny claims. These insurers hope the claimant will not have the means or capacity to content the rejection.
Insurers will often attempt to deny long-term insurance claims for many reasons, including:
- Missed payments. Policyholders must make continuous payments in order to receive coverage. However, as policyholders grow older, it can be easy to make simple mistakes, especially if a chronic medical condition results in cognitive impairment. Insurance companies must follow specific steps to void policies in instances of late payment or nonpayment, and a doctor’s note explaining cognitive impairment can help reinstate a lapsed policy.
- Disputes over a policyholder’s medical eligibility. When a policyholder submits their claim, they will be expected to include a medical diagnosis and a note from a doctor recommending ongoing care. The condition warranting the care must follow within the policy’s terms, and the insurer may provide the submitted information to their own medical examiner. This examiner could disagree with the policyholder’s doctor’s recommendation despite never examining the policyholder in person, leading to a denial of coverage.
- Suspected use of benefits for personal care. Long-term care benefits must be used specifically and exclusively for expenses associated with long-term care facilities or in-home caregivers. Caregivers generally assist with day-to-day menial tasks like dressing, cooking, and bathing. Insurers will sometimes balk and attempt to deny coverage if a caregiver is believed to be contributing to “personal care,” which are arguably inessential tasks like home repairs, cleaning, and errands. What is considered “personal care” can often be arbitrary, and insurers will sometimes look for any excuse to deny benefits.
- Disputes over a policyholder’s capacity. Long-term care policies will typically require that a policyholder can no longer independently perform essential day-to-day activities like eating, dressing, and cooking before issuing benefits. In some situations, a policyholder’s condition allows them to perform some or all of these tasks in a limited capacity. Insurers will sometimes use this limited ability to justify denying coverage, even if it is not safe or advisable for the policyholder to live on their own.
We understand that many long-term care claimants have limited means and capacity to advocate for themselves. Our Fort Lauderdale long-term care insurance attorney at Martin J. Sperry, P.A. is committed to providing exceptional legal guidance to vulnerable individuals facing wrongfully denied claims. We will thoroughly review your circumstances and leverage our decades of experience to identify and pursue all available legal remedies and secure the compensation you need and deserve.