FLORIDA LONG TERM CARE INSURANCE CLAIM ATTORNEY

Long-term care insurance serves as supplemental insurance to the health insurance you may already have. Typically, middle-aged adults will have purchased long-term care insurance to guarantee that their care needs will be met when they get older. Long-term care insurance is specifically designed to cover the cost of care associated with the issues people are likely to encounter as they get older. These issues can come in the form of requiring assistance with activities of daily living such as feeding, bathing, dressing, continence, and transferring. The policies can also cover the cost of care and supervision associated with cognitive impairment. This form of insurance also covers different care settings, including home care, assisted living, and nursing homes.

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Florida long-term care insurance claim attorney Steven M. Dunn along with attorney Kevin Dunn empathetically and compassionately help those who have had their long-term care insurance claims denied or have, through no fault of their own, had their policies lapse.  The long-term care claims attorneys fight for the elderly to ensure they maintain their dignity and get the benefits they deserve.   

You may be looking for information on long-term care insurance for a family member or disabled loved one. Perhaps you or your loved one has had their long-term insurance claim improperly denied, or you may feel you need help activating your policy and starting a claim. If this is the case, we can help you. 

Background on Long Term Care Insurance

Nobody knows what the future has in store for them. The questions of how we will age and how long we will live concern everyone.  For most people, the uncertainty of aging is a scary thing to think about. This issue certainly was at the forefront of the planning for people who have purchased long-term care insurance. People who purchase long-term care insurance realize that while we do not know what the future has in store for us, we know that we want to ensure that our care needs are covered no matter how we age. 

Long-term care insurance was marketed and sold as a mechanism to pay for the exorbitant and escalating costs of long-term care. These policies come with a variety of different coverages and benefits. While not every policy provides the same coverages, some of the more prevalent coverages include home care, assisted living, and nursing home care. The policies also cover a variety of ancillary coverages, including home modifications, durable medical equipment, and homemaker services. 

If understood and used correctly, long-term care insurance policies can be an important tool for aging gracefully and with dignity. 

If you or a loved one are having problems accessing their long-term care insurance benefits or just want a better understanding of how the policy works, call a long-term care insurance attorney today. 

Frequently Asked Questions

The following information should not be construed as legal advice. You should consult legal counsel regarding your particular situation. The following information is intended to provide a general understanding of long-term care insurance and to explain how lawyers who specialize in long-term care insurance may be able to assist you.

How can your long-term insurance claim be denied? 

On their face, these policies provide important and valuable coverages. However, like any insurance contract, issues can and do arise. One of the most obvious and significant issues is a claim denial. 

 There are two ways to qualify for benefits under a long-term care insurance policy. The first is if the insured has a functional issue that necessitates assistance with their activities of daily living. The activities of daily living defined in almost every long-term care insurance policy are bathing, dressing, feeding, toileting, and transferring. The nuance in each policy is what degree of assistance is required and how many activities must an insured person require assistance with in order to trigger policy benefits. 

The second way to qualify for benefits under a long-term care insurance policy is the cognitive impairment trigger. Under the cognitive impairment trigger, the insured will qualify for benefits if they suffer from a cognitive impairment such as dementia, Alzheimer’s disease, or any other condition that affects memory and judgment.

The most common claim denial is based on the insurance company taking the position that the insured does not meet either of these benefit triggers. As mentioned earlier, every policy is nuanced, and the requirements for benefits differ with each one. Most often, mistakes in documenting or assessing care needs lead to denials. This occurs because of a lack of understanding of how the policy triggers work and how to present a solid claim.

The second most common denial is based on a dispute over whether a particular care setting or care provider is covered, including adult day care, home care, assisted living, and nursing homes.  Each policy has its own unique coverages. A policy schedule of benefits outlines what facilities and types of care are covered. If the insured person does not understand what is and is not covered, they can face a costly and potentially catastrophic denial. Understanding what your policy covers and how to present proper documentation are crucial to getting your claim approved.

Long-term care insurance policies are complex legal contracts entered into between the policyholder and the insurance company. The policies are drafted by attorneys and contain very nuanced and sometimes ambiguous definitions, provisions, and terms that have legal consequences. Furthermore, there are many laws that dictate how the policies are supposed to be constructed and interpreted. Therefore, anyone who is not versed in how the policies work and the laws that control them is at risk of having their claim denied. 

If you or a loved one are facing a long-term care insurance claim denial, call now and have the long-term care insurance attorneys fight for you. 

Why are my premiums going up so much?

Like any type of insurance policy, long-term care insurance companies rely on actuaries to calculate various factors to price their insurance products. Unfortunately, in the case of long-term care insurance, the actuaries who wrote these policies decades ago relied on many false or incorrect assumptions that today have resulted in exorbitant premium increases for millions of policyholders. 

Actuaries assumed that many people who purchased these policies would either stop paying them after a few years or that if people did go on to collect their claim, their life expectancy would be quite short. Therefore, the insurance companies flooded the market with underpriced policies. However, both assumptions ended up being incorrect. The result is that the insurance companies now face massive claim liabilities, which in some cases threaten them with potential liquidation.

 Given the immense harm that would result from an insurance company going out of business, the state’s insurance commissioners have approved massive premium increases so that the insurers can keep paying claims. Unfortunately for insured persons, the burden falls on them and at the worst possible time because most policyholders are either already claim eligible or are not far off from claim eligibility, meaning they already need or will soon need care that their policies cover. Even worse, most of the insured people are already elderly and living on limited fixed incomes, making paying these premiums nearly impossible. 

So, what can an insured person do to fight these premium increases? One option is to take a reduction in benefits in exchange for a reduction in premiums. However, they must be aware of what they are giving up in exchange for that reduction. Many do not realize just how substantial a compromise they are making. The other option is to speak to a long-term care insurance attorney who can assist you in properly analyzing your options. 

How can a long-term care insurance policy lapse? 

Long-term care insurance policies are guaranteed renewable policies. The insurance company cannot cancel guaranteed renewable policies for any reason if the insured continues to pay their premiums. However, premium payments must be made continuously and on time, or the policy will lapse. The issue with long-term care insurance policies is that insureds continue to hold on to them as they age. Unfortunately, sometimes seniors suffer from cognitive impairment and simply forget to pay their premiums. 

In other cases, perhaps they were recently hospitalized and could not manage their finances. Because it’s not uncommon for older adults to suffer from memory lapses, or their health situation makes it impossible to pay bills on time, many states have crafted laws that aim to protect seniors from losing this valuable coverage. However, while many states provide some protection for policyholders, the laws vary from state to state. Additionally, those laws tend to be nuanced, technical, and have strict time limits. Therefore, it is complicated for the insured to avail themselves of the state law protection without legal representation. 

Insured people who are facing a policy lapse have had their long-term care insurance policies for years. They paid their premiums with the expectation that when the time came, they would be protected. Sadly, when a policy lapse does occur, it usually occurs when the insured is most in need of care. Do not let this crucial insurance coverage disappear. If you or a loved one have a lapsed policy, do not hesitate to call a long-term care insurance attorney. 

Long Term Care Insurance Claim Lawyer in Florida

Steven M. Dunn is a Florida long-term care insurance attorney who has been practicing law for over three decades. Following his personal experience fighting an insurance company on behalf of his father, he has spent the last 16 years focusing primarily on helping seniors and their families facing long-term care insurance disputes. For many of his clients, these are more than disputes: they are crises.  He is honored to help and advocate for our vulnerable seniors. Call now to set up your consultation.

OUR ATTORNEYS

Irving E. Dunn
1951-2012

Steven M. Dunn
PRINCIPAL

Kevin M. Dunn

ASSOCIATE

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