Oakland Long-Term Care Insurance Attorney

Oakland Long-Term Care Insurance Attorney

Many families struggle with finding affordable and safe care for seniors. So if you or a loved one purchased long-term care insurance coverage, you may be understandably upset when you receive notice that the claim for care was denied. While these policies were designed to provide security, insurance companies are facing financial difficulties due to the increasing number of claims from an aging population. Many insurers have altered their policies to offer fewer benefits, but they are still obligated to honor existing policies. This puts them in a tight spot financially, causing them to look for reasons to deny long-term care claims. 

At Monahan Tucker Law, we understand these challenges and specialize in navigating through them. We know that claims tend to be complicated and time-consuming, which makes having an experienced Oakland long-term care insurance attorney in your corner a wise choice. If your long-term care claim has been denied, reach out to us to learn how we may assist you.

Long-Term Care Insurance

Long-term care insurance pays out benefits based on serious illnesses or injuries that require long-term care, such as the services provided by nursing homes, assisted living facilities, and in-home caregivers. The kinds of precipitating events that typically trigger long-term care cases include:

• Chronic illness
• Physical or mental disability
• Cognitive impairment
• Any other condition that requires assistance with the activities of daily living

Often – but not always – those who are beyond retirement age require long-term care benefits. 

Long-term care policies generally cover a wide range of services that aren’t usually covered by health insurance, including in-home assistance to enable seniors to stay in their home while receiving needed care. As more and more people recognize just how easily the need for long-term care can wipe out their savings and estate, purchasing long-term care coverage is becoming more and more common. 

Coverage can come as an employee benefit, which is regulated by the federal Employee Retirement Income Security Act (ERISA), or as individual coverage.

Eligibility for LTC Benefits

Every LTC policy includes its own contractual language that determines the kinds of benefits available and when eligibility for benefits is triggered. While older policies sometimes incorporate terms like medical necessity, newer policies generally require an inability to perform two or more activities of daily living (ADLs). Examples include:

• Being unable to bathe independently
• An inability to prepare food or eat on one’s own
• Concerns related to continence or using the toilet
• An inability to get in and out of bed or a chair

An impairment that restricts an applicant’s ability to perform necessary activities alone, however, is unlikely to meet the level of need for a long-term care claim. Generally, a physician must weigh in on the matter by signing off on the related impairments and recommending a care provider whose services meet the individual’s needs. A skilled attorney can help you navigate these requirements.

LTC benefits usually begin once the elimination period – the amount of time that must pass between the precipitating event and the receipt of benefits – has passed, which is generally 90 days. 

Reach Out to an Experienced Oakland Long-Term Care Insurance Attorney Today

The skilled Oakland long-term care insurance attorneys at Monahan Tucker Law are committed to protecting your rights and fighting for the long-term care benefits that you are not only entitled to but that you also need to continue living your life to the fullest To learn more, contact us today.