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The claims process involved with long term care insurance benefits doesn’t have to be difficult. Unfortunately, many insurance companies often make it difficult – leaving policyholders confused and angry. In order to make the claims process easier, there are certain things you should know.

How long should the claims process take?

Dan Thornburgh, a Florida attorney whose firm represents long term care policyholders, says that the claims process should be completed in a reasonable amount of time. He explained:

Once you make a claim, it really depends on the language in the contract. It could be 30 or 60 days following submission of the paperwork. But, it certainly should be done within a reasonable time. If it takes longer than three of four months, you might have a real problem. Meanwhile, when you’re functionally incapacitated and you’re living in an assisted living facility, you need that policy to be applied right away.

You have to look at the contract and try to make sure that there’s language that really puts the onus on the insurance company to make a determination as soon as possible. If you’ve been sitting in a long term care facility, applied for benefits and months have gone by without a response from the insurer, it might be time to contact an attorney at that point.

Important policy language

Thornburgh says that consumers should also look for specific language in their long term care policies in order to make the claims process easier. He pointed to the three areas in particular:

• Appeal process. I think one of the most important things to be aware of is whether or not there’s an appeal process that has to be taken. So, if they are denied a claim, there may be only 30 days to appeal the denial. If that’s the case, they need to make sure they jump on that right away and act as fast as possible to appeal. If that appeal is later denied, they should certainly contact a lawyer.
• Arbitration clause. It’s also important to see if the contract requires arbitration. I prefer to try a case without going in front of an arbitration judge as I like the jury to make that decision. However, even if there is an arbitration clause in a policy, sometimes an attorney can fight that and keep it in front of a jury.
• Assessment rights. Finally, it’s important to see if the insurer has a right to have an assessment done after your own doctor has certified you as being chronically ill. Often times, there’s a small clause that allows for an assessment and you have to be really careful to determine who the assessor will be.
  
  Important questions to ask might be: Will the assessor follow the same criteria that your doctor is following? Is the person who’s doing the assessment qualified? Is he or she more qualified or less qualified than your own treating doctor and is this assessor represented or working for the company or are they an independent party?

If your long term care insurance company has denied your rightful benefits, it may have acted in bad faith and you might want to contact an attorney whose practice focuses in this area of the law. Consultations are strictly confidential, free of charge and without any obligation. To contact a qualified attorney, please click here. We may be able to help.