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Georgia Long-Term Care Insurance Denials

Long-Term Care Insurance Claims

Long-term insurance is one way to protect family assets and hedge against the high cost of long-term care when an elderly family member is no longer able to live on their own or take care of themselves. Because of declining health, these individuals often require long-term care in the form of home care, nursing home care, assisted living, nursing home care and other long-term care arrangements. Unfortunately, long-term care insurance denials are increasing at an alarming rate, partly because insurance companies did not anticipate the number of claims for this type of care or the amount of money each claim would entail.

Long-Term Care Insurance Denials

Because of these economic pressures, and for a number of other reasons, both major insurance companies and smaller ones who have written these policies are taking a hard look at each claim for long-term care and denying claims for many reasons. What should be a straight-forward process, i.e., the beneficiary’s health deteriorates to the point that they need long-term care to survive and they file a claim for the benefits, is often protracted and hotly contested. Often, the claims denial is not proper or lawful and the insured must timely contest the denial or lose the benefit for which the paid and for which they contracted under the insurance policy.  Whether you or a loved one is placed in a nursing home, an assisted living facility, or receiving in-house care, there are many factors in long-term care insurance policy coverages. Fundamentally, there are several ways in which your insurance company could deny your claim.

For example, although you may be approved for specific treatments and services, your claim may be denied because you are approved for a nursing home but the facility in question is considered an assisted living facility. Another reason that an insurance company may try to deny your long-term care claim is when the insured is no longer capable of carrying out major life functions, but the insurance company contests this fact. There are other common reasons that insurance companies use to try to avoid paying these types of claims, but the vast majority of the denials are very fact-specific. These type of denials tend to be very fact-specific  and/or policy language based. Seemingly minor details can make all the difference in the outcome of your long-term care insurance claim.

Whether it is delay tactics or an outright denial, many long-term care insurance companies understand very well that many beneficiaries and their families can become frustrated with the claims process and give up, or not know hot to contest the delays and denials. However, there are strict deadlines and other strict appeals and claims processes that must be adhered to or your right to the long-term care benefits under your policy will be lost. Most times, once you suspect that the insurance company is not acting in good faith, it is best to seek legal assistance in order to protect your rights under the policy.

Contact Us Today To Discuss Your Long-Term Care

Robert J. Fleming has been handling cases involving insurance issues for individuals and families for over 20 years. He practices in and around the Atlanta, Georgia area including handling lawsuits in Fulton, DeKalb, Clayton, Gwinnett, Cobb and other counties and nearby cities such as Alpharetta, Chamblee, College Park, Conyers, Duluth, Decatur, Doraville, Hapeville, Johns Creek, Jonesboro, Lawrenceville, Norcross, Peachtree City, Riverdale, Roswell, Sandy Springs, Stone Mountain, and Smyrna. If you have a long-term care insurance denial situation and would like to discuss your case in complete confidence, contact Robert J. Fleming directly on (404) 525-5150 or contact us online.