Activities of Daily Living (ADLs) play a crucial role in Long-Term Care (LTC) claims. At Monahan Tucker Law, we understand the significance of ADLs and how they can impact the outcomes of these claims. In this blog post, we will explore the role of ADLs in LTC claims, as well as the challenges that claimants may face.
Long term care claims involve seeking benefits for individuals who are unable to perform certain ADLs without assistance. ADLs refer to essential tasks that individuals need to perform in order to live independently, such as bathing, dressing, toileting, transferring, eating, and continence. Insurance companies use ADLs as a criterion to determine eligibility for LTC insurance benefits.
To qualify for LTC benefits, an individual must be unable to independently perform at least two ADLs. The level of assistance required, whether it is minimal, moderate, or maximal, is also considered. When applying for benefits, it is important to provide detailed information about the impact of these deficits on the individual’s everyday life and independence.
Assessments of ADLs can be conducted by family doctors or occupational therapists. These assessments evaluate an individual’s medical well-being and ability to perform ADLs. If an individual meets the criteria for deficits in ADLs, they are typically eligible for long term care benefits.
Long term care insurance policies include specific language around the criteria for deficits in ADLs. Each policy is different, but often the governing term is “substantial”- as in needing “substantial” assistance performing two or more ADLs. But what constitutes “substantial”? The word may be defined in the policy. If it’s not, then the insurer is likely to argue that your issues with ADLs do not rise to the level of needing long term care.
The amount of compensation awarded in long term care claims varies depending on the specific policy and the individual’s circumstances. Compensation is typically based on the type of care needed. It may limit you to specific amount per day, or pay based on monthly bills. Most long term care policies now have a total dollar limit on them, after which no more benefits will be paid.
Claimants may encounter challenges during the long term care claims process. Insurance companies may deny claims or terminate benefits without adequate investigation. In such cases, it is crucial to have an experienced attorney who can navigate the legal process, gather necessary evidence, and advocate for the claimant’s rights.
At Monahan Tucker Law, we have a long history of success in handling these claims. Our team of dedicated attorneys understands the complexity of these claims and is committed to achieving the best possible outcomes for our clients. We work closely with each client, providing legal guidance and representation with integrity, compassion, and a commitment to their unique needs.
If you are facing challenges in your long term care claim, don’t hesitate to reach out to Monahan Tucker Law. Our lawyers will assess your case, provide a comprehensive evaluation, and guide you through the process. With our knowledge and experience, we will fight for your rights and help you secure the benefits you deserve.
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