When you buy long-term care insurance, you trust the insurance company to cover your care when you need it most. Too often, insurance companies acting in bad faith deny claims to avoid making payments. If this happens to you, here’s what you should do next.
Gather and Keep as Much Information as Possible
Start by finding your original policy documents, billing statements and any other information you have about your policy. Insurance companies may cite requirements that are not really in your policy or claim you did not pay premiums when you did. Having your documents at hand can help refute those claims. Providing policy documents, billing statements, and claim correspondence helps your attorney determine the strength of your claim for benefits.
Request a written explanation for any denial of benefits. This documents that the claim was denied and, more importantly, locks in the reasons why. It allows you to focus on rebutting the insurance company’s reason for denying your claim and reduces the chance of them coming up with other excuses. The better idea your attorney has about why your claim was denied, the more accurately your attorney can evaluate your case.
Carefully Check All Deadlines and Requirements
Even if an insurance company is refusing to pay benefits on what seems like a technicality, it is important to try to play by their rules, no matter how frustrating it gets. Be careful to avoid giving the insurance company a technical excuse to deny your claim. For example, pay attention to deadlines for making a claim or submitting proofs, to what medical documentation is requested, and to who needs to submit the information and in what form.
Of course, your insurance company is not entitled to impose requirements not in the contract or make filing a claim so unreasonably burdensome that it is virtually impossible for you to comply.
Work with a Lawyer
Some long-term care insurance providers have sold more insurance than they can cover and are looking to deny as many claims as possible. Even when insurance companies are solvent, paying claims reduces their profits. Some insurers even create direct financial incentives for claims handlers to help company profits by denying claims. The conflict of interest is clear, and some companies yield to their own financial interests and put policyholders second.
By contrast, your attorney is free to always put your interests first, and help you get the coverage you are entitled to. To schedule a consultation with an experienced lawyer about your long-term care insurance claim, contact Turbak Law Office, P.C. now at 605-886-8361.