Long term care insurance is designed to help policyholders pay for the care they need as they become ill or infirm and need help with the activities of daily living (bathing, dressing, eating, etc.). The particular services and level of benefits varies from policy to policy. Many policies cover care in a nursing home, assisted living facility, adult day care center, or your own home. Consult an insurance claim attorney to make sense of your policy details.
Insurance companies are happy to sell long term care insurance, but not happy to pay on it. If you experience difficulty dealing with the insurance company to pay for your care or the care of a loved one, speak with Rhode Island insurance claim attorney Jonathan M. Feigenbaum, Esquire.
Why Insurers Don’t Pay
Underpricing due to bad underwriting.
Many LTC policies sold in the 1980s and 1990s were priced too low. Insurance pricing problems were not evident when the policies were sold. Only years later when many more claims rolled in than the number the insurance actuaries predicted did the pricing issue become front and center.
Assumptions regarding the lapse rates of long term care insurance – the number of persons who would pay for policies for a few years and then stop – were wrong.
The loss ratio (the receipt of premiums plus investment income), compared with the dollar amount of claims paid, has been far greater than anticipated for some insurance companies. In other words, for every $1 the insurance company receives, it may be paying out $2 in claims. As a result, insurance companies that did not price their policies adequately have a tendency to deny many claims.
Getting long-term disability claims paid can be difficult, frustrating and time consuming. Too often, people who need these insurance benefits don’t have the energy or mental faculties to fight with the LTC insurance company. Children of elderly parents may not live close by and cannot readily help their parents get the LTC benefits that they paid for long ago.
Exclusions and limitations hidden in the “fine print.”
The “fine print” in LTC insurance or the insurer’s interpretation of ambiguous language too often causes an insurance company to deny benefits. For example, often insurance companies will not pay for claims relating to an assisted living facility. An insurance company’s will commonly deny claims on grounds that the facility is not properly licensed. Not all states license every type of facility that policy owners typically expect LTC insurance to pay for.
Other disputes may relate to exclusions in the policy. For example, the insurer may incorrectly claim an excluded pre-existing condition, mental disorder, or alcoholism or drug addiction caused your illness or disability.
We Fight for Your Long Term Care Insurance
We can help you or your elderly family member in need of assistance. For almost 30 years, Rhode Island insurance claim attorney Jonathan M. Feigenbaum helps people get the insurance benefits they deserve. Most often, we work on a contingency fee basis. That means you do not pay for our services on an hourly basis. We receive compensation only if you win Not every claim fits this mold, but most do. Let us take a look at your LTC policy without charge to you. Reach us by phone at 617-357-9700, or toll-free at 866-396-9722, or online.
Serving individuals in Massachusetts, Connecticut, Rhode Island, and New Hampshire.