Long Term Care Insurance Claims Denied, Denied, Denied

Baltimore, MDWith seniors living further and further into retirement, it is important that they have a solid financial plan to ensure their needs are met. One tool for financial planning that many seniors consider is long term care insurance, which provides them with a means to pay for their care, should they need it. Unfortunately, long term care insurance benefits can be tricky to understand, and more and more seniors are finding that their claims are being denied on a questionable basis.

One of the problems with long term care insurance is that many contracts were signed years ago, before new types of care facilities existed. People trying to live in such facilities are finding that their claims are denied because that type of facility was not included in their insurance policy.

For example, a policy may cover and define convalescent care. If the policy was written in the 1980s or 1990s, it would not include assisted living facilities because they did not exist at that time. Based on that, some long term care insurance companies are denying claims, arguing that assisted living facilities are not covered under the definition of convalescent care. Taken a step further, the policy may have a definition of what a long term care facility entails but does not include assisted living facilities.

The thing is, assisted living facilities are crucial for many seniors. They provide a place to live for seniors who need help with daily living activities but still wish to remain as independent as possible. Assisted living facilities provide a home for seniors who are not in need of a nursing home but cannot quite live fully on their own, either. For example, assisted living facilities might provide meals, help with laundry and housekeeping and assist with medications.

Clearly, assisted living facilities are vital tools in helping seniors maintain a sense of independence while ensuring that they have help when necessary. Furthermore, assisted living facilities ensure that space is available in nursing homes for people who need that space (nursing homes are generally for people who require a high level of care). So, why are long term care insurance companies denying claims for assisted living facilities?

It could be that they are losing a lot of money on long term care insurance and denying benefits is a way to minimize losses. However, it seems unethical for them to deny a claim for a care home simply because the facility did not exist when the policy was written, especially when the facility clearly provides care that seniors need, which was the purpose of purchasing the insurance policy in the first place.

It is not the senior's fault that society has advanced to a place where new facilities are being developed to aid in their care. It should be up to the long term care insurance provider to make sure that existing policies are reviewed to ensure that any new facilities are included in a policy.

Seniors who signed their policies in the 1980s and 1990s thought they were taking care of their future. They thought they were guaranteeing that, no matter what, they would be looked after. Now they are finding out that their care is not entirely guaranteed, simply because an incredibly useful facility did not exist when the policy was signed. Once again, they are stuck paying the bills for something they thought was covered—something they paid premiums on so they would not be in this position.

So now they are stuck. There are rising health care costs, their retirement funds are probably dwindling due to the economic climate and they are being told that their policy does not include assisted living facilities. They cannot live at home any more because they are not quite able to fully take care of themselves, but they cannot go to a nursing home, which would be covered by their policy, because they are still too independent.

These seniors are supposed to be living out their golden years with few worries—just happily enjoying their retirement. That is what they worked so hard their entire lives for. Who does not look to retirement as a relatively stress-free time, away from the worries of work and finances? Instead, these seniors now have to worry about whether or not they can afford the care they need, care they thought they had already paid for with their long term care insurance policy.

What can they do? They can contact an attorney to see if they have a case against their long term care insurance company. At the very least, they just may be able to get that assisted living facility covered.