Articles Posted in Long Term Care Insurance Claims

One common problem encountered by caregivers right after they’ve checked in their loved one at a local nursing home or Assisted Living Facility is whether the facility is one that is covered by the elderly parent’s Long Term Care Insurance policy.  Does it have enough staff?  Enough beds? 24/7 or other nursing care available?  What is the facility called and how is it licensed?

Unfortunately, the wrong answers to any of these questions may be grounds for the insurance company to deny coverage.  Rather than moving your loved one to another facility, or incurring the out-of-pocket expenses of the preferred location, reach out to a consumer or insurance attorney for help.  Most attorneys experienced in this area offer a free intake analysis or consultation to determine if legal representation is warranted.  Many represent the client on a contingency basis or hourly basis for short term matters with reasonable payment plans.

Administrative exceptions can be asserted to keep your loved one in the facility of choice.  Often it may be the threat of a lawsuit or public exposure to convince an insurance company to do what is right.

When a parent reaches the point of needing long term medical or assistive care, sometimes a family member cannot locate the actual policy even if they know a long term care insurance policy exists.  How do you get a copy of the policy?  One tactic used by insurance companies is to delay everything – including the simple task of complying with a request for a copy of the policy itself.  They also know that if the policy’s language (terms and conditions of coverage) is not consulted early on, damaging statements regarding the condition of the insured and the type of care needed are often made to the detriment of obtaining coverage for the insured.

Knowledge of and citation to the Florida statutes should help to get a copy of the long term care policy asap.

Florida law requires insurance companies to promptly communicate with policyholders:  “acknowledge and act promptly upon communications with respect to claims.”  Fla. Stat. § 626.9541(1)(i)3.c.  In addition, another Florida statute requires the insurance company to represent policy provisions accurately and relate claim decisions to applicable policy language.  See Fla. Stat. § 626.9541(1)(i)3.b and Fla. Stat. § 626.9541(1)(i)3.f, respectively.