Long-Term Care Insurance

A Record Of Results For Long-Term Care Insurance (LTC) Claims

Long-term care (LTC) insurance policies vary widely and many legal issues have yet to be resolved by the courts. As your long term care insurance lawyer can tell you, ailing, aged or incapacitated individuals and their families are devastated every day when their LTC insurance carriers tell them that necessary long term care benefits are not covered by the expensive long term care policy they purchased. And these are the policies they have been paying heavy premiums for years and years.

A major reason for these insurance denials is that insurers are relying on the “wimp” factor. This is a common malady as people grow older and become more infirm. Many legitimate claims are never paid because insureds choose not to challenge a denial of benefits by an insurance company. Insurance companies are happy to take advantage of policyholders who take “no” for an answer. This is the case even when the denial of benefits is wrongful. The lesson is clear: do not accept “no” without challenging it.

Experienced Long Term Care (LTC) Lawyers in NYC and NJ

Uscher, Quiat, Uscher & Russo, P.C.. are leaders in this burgeoning field of law. As long term care (LTC) lawyers in New York and New Jersey, we offer more than 40 years of experience in litigation and insurance law. If you have an inkling that you or a family member is being denied benefits when your policy calls for them, contact us immediately.

Long Term Care Insurance

Long-term care (LTC) insurance plans were devised to assure high quality care when a person is incapacitated and needs assistance with Activities of Daily Living (ADL’s). Policyholders and those thinking of buying an LTC policy should be sure that the terms of their policies permit them to choose an inpatient facility or an at-home care plan so as to avoid state-run nursing homes.

Proper long term care policies also eliminate the need to spend down personal assets so as to qualify for Medicaid. This is because a good LTC policy largely negates the shame and indignity of having to “qualify” for Medicaid.

Most policies cover 24-hour care and other needs:

• Nursing homes
• Assisted living facilities
• Home health aides
• Medical equipment

But, these policies also include exclusions and limitations that can derail a claim before it even starts. For more help in ascertaining your needs and how to time your purchase of an LTC policy take a look at this article.

Why Insurers Sometimes Deny Claims

Often the fine print in your LTC policy or the way the insurer interprets the policy language results in a denial of benefits. For instance, some policies will reimburse a family member who is willing to provide home care, but many do not. This forces families to turn over care of their loved one to strangers. Or, the insurer may deny payment for medical necessities, such as home appliances, wheelchairs, assisted transportation, lifts or home improvements to meet certain medical requirements.

Many times the insurer hangs its denial on a report provided by the policyholder’s doctor. Busy physicians don’t always take the time to fully and completely explain a patient’s condition. When that happens, an experienced LTC lawyer sees to it that the doctor’s report fully describes the policyholder’s medical status relative to the need for long-term care.

When your claim is denied, Uscher, Quiat, Uscher & Russo, P.C., will examine the specifics of your LTC policy and advise you on the best course of action. Some insurers negotiate. Other insurance companies take a hard stand, necessitating litigation. Our attorneys are veterans at trial and can answer your long-term care insurance questions throughout the process. We have successfully represented clients against most major insurance companies for over 40 years.

New York And New Jersey Long-Term Care Insurance FAQ

Insurance companies often make things tricky when you’re trying to get long-term care benefits. This can make the process confusing and overwhelming. At Uscher, Quiat, Uscher & Russo, P.C., we have compiled the best answers to the most frequently asked questions on long-term care insurance claims:

What types of long-term care insurance are available in New York and New Jersey?

Various types of long-term care insurance are available to meet diverse needs. These include:

• Traditional long-term care policies: Cover specific long-term care services
• Hybrid or combination policies: Combine long-term care with life insurance or annuities

It’s essential to explore and understand the features of each option to choose the one that aligns with your preferences and financial goals.

How do I establish whether I qualify for long-term care insurance claims?

Your New York and New Jersey long-term care insurance claims eligibility involves assessing your health condition and functional abilities. Your insurer evaluates if you require assistance with daily activities like bathing, dressing or eating.

Do I need a lawyer for my New York and New Jersey long-term care claims?

Yes, since this is a legal battle like any other, you are better off hiring a skilled New York and New Jersey long-term care insurance attorney. They can help you:

• Assess your long-term care policy and benefits coverage
• Review your long-term care claim
• Navigate insurance company roadblocks
• Understand the alternative legal options available

Why can an insurance company deny my long-term care claims?

An insurance company may deny your long-term care claims due to reasons such as policy exclusions, insufficient documentation, failure to meet eligibility criteria or nondisclosure of relevant information. Each case is unique, but the need for competent legal representation applies to all claims.

What is hybrid long-term care insurance?

Hybrid long-term care insurance is a versatile policy that combines the benefits of traditional long-term care coverage with elements of life insurance or annuities. These policies allow you to address the need for long-term care while also providing a financial safety net through a life insurance component. With hybrid policies, if you don’t end up needing long-term care, the policy can still benefit your heirs. It’s designed to offer more flexibility and peace of mind when planning for the future. As you consider your options, it’s crucial to review the specific features and benefits of a hybrid policy to ensure it aligns with your financial plans and provides the coverage you might need.

What is not included under long-term care insurance?

Long-term care insurance generally does not cover medical expenses like doctor’s visits or hospital costs covered by health insurance or Medicare. Certain policies may exclude mental health treatment, substance abuse recovery, and injuries caused by self-harm. It’s important to check your policy for specific exclusions or consult with a long-term care claims attorney in New Jersey/New York for clarification.

What is the biggest drawback of long-term care insurance?

The primary drawback of long-term care insurance is its cost. Premiums can be quite expensive, especially as you age, and they may increase over time. It’s also important to note that there may be limitations on coverage, and some individuals may not qualify for a policy due to preexisting conditions. When evaluating long-term care insurance, consider these factors:

• Policyholder’s age
• Annual payout limit
• Daily limit
• Lifetime cap
• Optional benefits

Understanding these potential downsides is crucial when considering whether long-term care insurance is the right choice for your financial planning.

What are my legal rights if my long-term care insurance claim is rejected?

To Ensure the Best Long-Term Care for Your Loved One, Make Arrangements With a Long-Term Care Insurance Lawyer in NJ and NYC

We have many years of experience in the long-term care insurance laws of New Jersey and New York. Our long term disability lawyer can review an LTC policy if you are planning for care. We can also represent you if your claim has been denied. Call (201) 342-7100 or send an email for help today