Dirty Little Secrets About Long Term Care Insurance
By: Carolyn L. Rosenblatt, R.N., B.S.N., Attorney
The insurance industry is working hard to get more baby boomers to buy long term care insurance. Generally speaking, it’s a very good idea. The cost of care is shocking, and few seem to plan ahead for it. It can wipe out savings, drive us to bankruptcy, and impoverish a family very quickly. So what’s the problem?
What the brokers, sales representatives and others selling us products don’t mention is that when it comes to claims, some of these long term care insurers will do anything and everything to get out of paying you your benefits. “Delay, deny, avoid” is the tactic. Sound familiar? Remember, this is health care insurance. The owners who run these companies are doing so to make a profit.
What they don’t want to have to do is pay out on all the policies they sell. They’re counting on not paying every claim to keep their profits high and executive salaries and bonuses fat. The sad thing is that many elders who purchased long term care insurance thirty years ago (when they could qualify for it) didn’t know what they were really getting, and some companies who sold them products were less than truthful.
I’ve spent decades dealing with insurance of many kinds, particularly health insurance. Representing injured persons frequently puts one in touch with health insurers, large and small. The tactics I am now seeing in long term care insurance claims are sickeningly familiar. Yes, essentially ethical long term care insurance companies do exist. However, there were many companies in business over the last thirty years or so, who were not ethical, and their methods of handling claims reveal the extent of their ugly ways.
A claim is presented. The claimant is told the claim “doesn’t meet requirements” or some other nonsensical thing designed to baffle and confound the consumer/policy holder. As one cannot collect benefits until becoming infirm in several ways defined by most insurers, the likelihood of being able to fight for these benefits is reduced. The elder may not be able to aggressively pursue what he deserves to get under the policy.
It can take persistence and serious work on the part of an advocate for the insured to access the benefits the elder has been paying for in his/her premiums for many years. The insurer will fight the claim for as long as possible, making it very exhausting to keep making the claim when various obstacles are thrown up in the insured’s path.
How often is this “deny, delay, avoid” tactic used by long term care insurers? Often enough to cause major media outlets to report the increases in denied claims, and often enough that we are encountering it in our practice at AgingParents.com. We see some elders unable to get what they paid for because they do not have the knowledge or ability to fight back when their legitimate claim for benefits is denied.
If your aging loved one bought such an insurance policy from one of the “bad apple” companies and can’t get benefits for which he is eligible, we encourage you to seek legal advice. A competent elder law attorney, or “bad faith” attorney with skill in going after insurance companies can help you. Legal advice of this kind is specialized and generally is not free. However, there is much at stake, and getting help to access what an elder deserves under any insurance policy is worth the attorney’s fee.
If you or your elder or client has been denied when making a legitimate claim for benefits under a long term care insurance policy, and you have questions, call us at AgingParents.com, 415 459-0413 or 866-962-4484.
Ó 2009, AgingParents.com
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