Like many individuals, you might have chosen to invest in a long-term care policy to prepare for the possibility of needing vital assistance in the future. Your insurance policy represents a promise for your future well-being, and keeping this promise is important. While long-term care insurance can prove invaluable, its true worth is determined by the benefits it provides when you require it.
When your long-term care insurance provider fails to honor their commitment, our San Jose long-term care insurance lawyers can be your ally in holding them accountable. With our help, you can focus on your care needs without the added stress of legal battles, ensuring that your insurance works for you when it is needed most.
At Kantor & Kantor, we are not just San Jose long-term care insurance lawyers – we are people helping people and allies in the fight for fair treatment and financial security. With years of experience serving clients throughout San Jose and California, we have built a reputation for delivering results and advocating tirelessly on behalf of our clients.
Whether you are facing a denied claim, navigating the appeals process, or simply seeking clarity on your policy benefits, we are here to help. Our team combines legal expertise with personalized attention to ensure that you receive the guidance and support you need every step of the way. Let us be your trusted allies in securing the benefits and peace of mind you deserve. Contact us at 408-539-0081 to schedule a free consultation and take the first step toward protecting your future.
We offer a free case evaluation to discuss how our attorneys can assist you. Contact us now at 408-539-0081 for a free consultation.
Understanding Long-Term Care Insurance
Long-term care insurance (LTC) is a vital component of comprehensive financial planning, covering the costs associated with long-term care services, including assistance with activities of daily living (ADLs) such as bathing, dressing, and eating. As individuals age or face debilitating health conditions, the need for long-term care may arise, making long-term care insurance an essential safeguard against the high expenses of extended care.
Qualifying for LTC insurance involves meeting specific criteria related to age, health, and the insurance company’s underwriting guidelines. Insurance companies assess potential policyholders based on factors that predict their likelihood of needing long-term care in the future. The six Activities of Daily Living (ADLs) are basic self-care tasks that are essential for independent living and these tasks are commonly used to assess a person’s ability to function and determine the level of care they may require, particularly when applying for long-term care insurance or benefits. The inability to perform a certain number of these ADLs often qualifies a person for assistance or long-term care benefits.
The following are the six ADLs:
- Bathing: The ability to wash oneself in the bath or shower, including the ability to get in and out of the tub or shower safely.
- Dressing: The ability to select and put on appropriate clothing, as well as being able to take the clothes off when needed. This also includes tasks like fastening buttons and zipping zippers.
- Eating: The ability to feed oneself, including bringing food to the mouth and chewing/swallowing, but not necessarily the ability to prepare meals.
- Transferring: The ability to move from one place to another, such as getting in and out of bed, standing up from a chair, or moving to and from a wheelchair.
- Toileting: The ability to use the toilet, including getting on and off the toilet, maintaining hygiene, and managing personal hygiene related to continence.
- Continence: The ability to control both bladder and bowel functions or manage incontinence effectively if necessary.
However, generally, there are two separate ways to qualify for LTC insurance: Be physically impaired and thus unable to perform two of the six ADLs; or have severe cognitive impairment.
What Does Long-Term Care Insurance Cover?
LTC insurance typically covers a range of services and support needed for individuals who cannot independently perform ADLs or require supervision due to cognitive impairment. These services may include:
- Nursing Home Care: Care benefits are provided in a skilled nursing facility for individuals who require around-the-clock medical supervision and assistance with daily tasks.
- Assisted Living Facilities: Benefits for services provided in assisted living facilities, which offer assistance with daily activities while promoting independence and social engagement.
- In-Home Care: Benefits for home health care services, including assistance with bathing, dressing, meal preparation, medication management, and other activities essential for daily living.
- Adult Day Care: Benefits for daytime care services provided in a structured setting for individuals who require supervision and socialization while family caregivers are unavailable.
- Hospice Care: Benefits for end-of-life care services, including emotional support, pain management, and assistance with activities of daily living for individuals with terminal illnesses.
Why Was Your LTC Claim Denied?
While LTC policies offer valuable protection, policyholders face various challenges when accessing benefits. Below are some common obstacles policyholders may encounter:
1. Substantive Denial of Claims
One of the most frustrating challenges policyholders face is the denial of their insurance claims due to disputes over the necessity of the care provided.
2. Policy Lapses and Cancellations
Policyholders may inadvertently allow their LTC insurance policies to lapse or be canceled due to missed premium payments or other administrative errors. While your policy may lapse, insurance companies must alert you to the lapse and provide proper notice. Further, lapses can, and do, occur as a result of the insurance company’s error. If you notice the mistake before you need to make a claim, the insurer will often require you to reapply for the insurance and deny coverage.
3. Coverage Disputes
Disputes over what services are covered under a LTC insurance policy are not uncommon. Policyholders may disagree with their insurance companies regarding the scope of coverage for specific care services, leading to confusion and frustration. These disputes can prolong the claims process and create additional stress for policyholders and their families.
For example, while some policies cover at-home nursing care, other policies only cover nursing homes. All policies have requirements for both. Ultimately, even if an insurer agrees that a person needs and qualifies for care, the insurance company may argue that the person is not receiving care from a qualified person/entity in order to deny a claim.
We are people helping people and allies in the fight for fair treatment and financial security.
Why Choose Kantor & Kantor?
As leading long-term care insurance attorneys in San Jose, we understand the intricacies of insurance policies and the legal framework surrounding long-term care benefits. Our team is equipped with the knowledge, skills, and resources necessary to effectively represent clients in all aspects of their long-term care insurance claims, including:
1. Expertise in Long-Term Care Insurance Law
Our firm focuses on long-term care insurance law, giving us a depth of knowledge and experience that few others possess. We stay abreast of the latest developments in this complex field, allowing us to provide cutting-edge representation tailored to the unique challenges of long-term care insurance claims.
2. Accessible and Responsive
We believe in open communication and transparency with our clients. Our attorneys are accessible and responsive, providing regular updates on case developments and promptly addressing our clients’ questions or concerns throughout the legal process.
3. Support During the Appeals Process
Navigating the appeals process can be daunting, but you do not have to do it alone. Our experienced San Jose long-term care insurance attorneys will guide you through every step of the appeals process, advocating for your rights and best interests.
4. Skillful Litigation
In cases where negotiation and appeals prove unsuccessful, our skilled litigators are prepared to take your case to court. With a record of accomplishment of success in litigation, we relentlessly pursue justice for our clients.
5. Policy Review and Analysis
Understanding the terms and conditions of your long-term care insurance policy is crucial. Our attorneys will thoroughly review your policy, identify potential issues or ambiguities, and provide clear and concise guidance on your coverage rights.
6. Compassionate Support
Dealing with long-term care insurance issues can be emotionally taxing, but you do not have to face them alone. Our team provides compassionate support and guidance throughout the legal process, offering reassurance, empathy, and practical solutions to help alleviate your stress and uncertainty.
How We Can Help With Your Case
At Kantor & Kantor, we are committed to providing comprehensive legal assistance and support to individuals and families in San Jose who are struggling with their long-term care insurance claims. Here is how we can assist you:
1. Complete Policy Review
The dense and often confusing language can make understanding your LTC insurance policy difficult. Our team will meticulously review your policy to identify the coverage details, benefits, exclusions, and any potential issues that might arise. We will explain the terms in plain language, ensuring you fully understand your entitlements and obligations.
2. Claim Filing Assistance
Filing a LTC insurance claim requires detailed documentation and strict adherence to the policy’s procedures. Our attorneys will assist you in preparing and submitting your claim, ensuring all necessary documentation is included and accurately completed. By proactively managing the claim filing process, we help minimize the risk of delays or denials.
3. Appealing Denied Claims
Insurance companies may deny claims for different reasons, often leaving policyholders feeling helpless. If your claim has been denied, our San Jose LTC insurance lawyers will conduct a thorough investigation to understand the basis of the denial. We will then prepare a comprehensive appeal, challenging the denial with strong legal arguments and supporting evidence. Our team is dedicated to reversing unjust denials and securing the benefits you deserve.
4. Addressing Policy Lapses
Policy lapses or cancellations can occur for various reasons, including missed payments or administrative errors. If your policy has lapsed, we will investigate the circumstances and work to reinstate your coverage. We will also advise you on steps to prevent future lapses, ensuring continuous coverage and protection.
5. Coverage Disputes
Disputes over what services are covered under your policy, or the manner in which they are covered, can lead to confusion and denial of necessary care. Our lawyers are adept at interpreting policy language and will advocate for your rightful coverage. We will engage with the insurance company to clarify ambiguities and ensure you receive the full range of benefits your policy provides.
6. Litigation Support
In some cases, legal action may be necessary to secure your benefits. Our firm is prepared to take your case to court if needed. With extensive experience in litigation, our attorneys will build a compelling case and represent you vigorously in legal proceedings.
Contact a Long-Term Care Insurance Attorney in San Jose Today
If you face challenges with your long-term care insurance claim, contact our San Jose long-term care attorneys immediately. Schedule a free consultation at 408-539-0081 with one of our knowledgeable long-term care insurance attorneys.
Let us put our expertise to work for you and help you secure the benefits you need to ensure peace of mind and financial security for the future.
Attorney Glenn R. Kantor
Glenn Kantor is a founding partner of Kantor & Kantor LLP. As a young attorney, Glenn saw the injustice of wrongful insurance denials and created a law firm to represent individuals seeking to obtain their rightful benefits. Glenn is committed to ensure that clients receive the benefits they are entitled to under their insurance policies or group health plans. [Attorney Bio]
