Tips for Filing a Long-Term Care Claim

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Long-term care claims can be extremely difficult to manage on your own. The process can seem convoluted and overwhelming, especially when dealing with the emotional and physical stress that often accompanies the need for long-term care. Monahan Tucker Law is here to help illuminate the path. We are experienced in helping our clients and their families navigate the world of long-term care claims, and we have some tips to share to make this process easier for you.

Establishing Eligibility

To begin, it’s essential to understand the eligibility requirements for filing a long-term care claim. These typically include proving that the individual in question is unable to perform at least two Activities of Daily Living (ADLs) without assistance. ADLs might include bathing, dressing, eating, toileting, transferring, or maintaining continence. What does it mean to require “assistance”?  This is an issue that insurers use to deny claims.  The policy likely does not specify whether the insured needs to require assistance in every instance, or in certain situations or at certain times of day. Does the policy define assistance?  Does “assistance” mean “hands-on” assistance, or having a monitor available in case of a fall or difficulty with an activity? The policy definition will control. Insurers will often add their own unofficial requirements when reviewing a claim – requirements not found anywhere in the policy language. These requirements are not enforceable, but the insurance company will not explain that to you.

Gathering Documentation

Your insurance company will take the lead in gathering the necessary documentation. This paperwork usually includes medical records, statements from healthcare providers, and proof of inability to perform ADLs.  You will be asked to sign authorizations for your medical records and to allow the insurer to speak with your treating physicians.  If your insurer has difficulty obtaining records, it may ask you for assistance in obtaining them. It’s important to keep all documentation organized and accessible. Remember, each piece of paper contributes to building a strong case. Understand, if the insurance company is unable to obtain the documentation they seek, it is ultimately up the insured to make sure that the insurance company receives all the documentation. 

Meeting Deadlines

The importance of deadlines cannot be overstated. Each insurance company has its own set of deadlines associated with filing a long-term care claim. Missing these deadlines could result in claim denial. Therefore, it’s crucial to be aware of these dates and ensure all necessary documents are submitted on time.

Avoiding Common Pitfalls

Even with all the right elements in place, there are common mistakes that can lead to claim denial. These include incomplete paperwork, miscommunication with the insurance company, and medical evidence that does not contain the information or the buzz words that the insurer wants to see. To avoid these pitfalls, it’s beneficial to seek legal counsel. An experienced attorney can help you navigate the process and ensure all necessary steps are taken to avoid claim denial.

Seeking Legal Assistance

Finally, it’s important to remember that you don’t have to go through this process alone. Seeking assistance from a qualified attorney can make a significant difference in the outcome of your long-term care claim. An experienced lawyer will understand the complex laws and regulations surrounding long-term care claims and can help you build a strong case for approval.

How Monahan Tucker Law Can Help

At Monahan Tucker Law, we stand up for you when insurance lets you down. Our team of experienced attorneys can assist in addressing legal obstacles, advocating for your rights, and appealing denied claims. We handle all logistics, making the process less stressful for you.

Our mission is to provide our clients with exceptional legal services that meet their unique needs and exceed their expectations. We are dedicated to seeing each client as a whole person, working closely with them to identify and achieve the results they seek. Your claim is our cause.

Contact Us for Legal Guidance

Filing a long-term care claim can be a complex process. However, with the right knowledge and guidance, it can be navigated successfully. You don’t have to go through this process alone. Monahan Tucker Law is here to assist every step of the way. Feel free to reach out to us- there is no cost for a consultation.

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