Long-term Care Insurance Claim

Long-term care insurance provides financial benefits to the elderly and infirm who need nursing care, home care and other health care services to assist them as needed and as provided for in their insurance contracts. This insurance is available outside of government benefits and is critical to the well-being of the millions of people who cannot fully take care of themselves.

Tomlinson Law Group can help establish whether you or a loved one qualifies for long-term care insurance benefits. Our skilled lawyers will fight to enforce the terms of the long-term care policy and get the benefits you or your loved one deserves.

Insurance Types

Tomlinson Law Group has substantial experience handling all types of long-term care insurance policies, including:

• Private Individual – purchased directly from a broker.
• Employer-Sponsored – offered by an employer and is not portable.
• Organization-Provided – offered through membership in a group or organization.
• State Partnership Programs – programs you pay into for long-term care, which also allow you to keep certain assets and still qualify for Medicaid.
• Joint Policies – policies covering more than one person, like partners, spouses and relatives.

What’s Covered By A Long-Term Care Insurance Policy?

While additional services may be offered in your policy, these services are the most common:

• Nursing Homes. Residences providing skilled nursing care on a regular basis because the insured is significantly impaired and needs 24-hour care.
• Assisted Living Facilities. The insured resides on the premises and gets some assistance, but doesn’t receive skilled nursing care around-the-clock.
• Home Care. A home health care aide, such as a registered nurse (RN), licensed practical nurse (LPN), or some other skilled health care provider, visits the insured regularly and might administer medication.

Additional services could include: adult daycare services, home modification or adaptation services, and care coordination services. Some policies will cover future services and alternative plans of care. Tomlinson Law Group will help determine the types of services your policy offers and whether certain facilities meet your state’s licensing standards.

Establishing Whether You Qualify for Benefits

One of the biggest difficulties insureds face when applying for long-term care benefits is establishing whether they are unable to perform certain activities of daily living. Tomlinson Law Group can help you make that determination, and properly present it to an insurance company to maximize the likelihood that the claim will be approved.

To qualify for benefits under these policies, you must prove your inability to perform certain “activities of daily living,” which include:

• Bathing
• Eating
• Dressing
• Toileting
• Continence
• Transferring

If a healthcare professional can certify that you cannot perform anywhere from 2 or 3 out of these 6 activities (refer to your policy for specifics), you should qualify for benefits.

Cognitive impairments, such as dementia and Alzheimer’s disease, are also qualifiers for benefits under long-term care policies. If you don’t have impairments that affect your ability to conduct your activities of daily living, but you suffer from a cognitive impairment, we can still help you claim your benefits.