Nevada Long-Term Care Insurance Denial Lawyer

Each year, countless families across Nevada, including in Reno, Las Vegas, Carson City, Henderson, Elko, Sparks, and everywhere in between, make one of the most challenging decisions of their lives. Those individuals have to decide whether to place a loved one in a long-term care facility such as a rehabilitation center, adult day care, or nursing home or to have a third-party, such as a homecare services company, step in and help.

Statistics compiled by the American Health Care Association (AHCA) in conjunction with the National Center for Assisted Living (NCAL) detail how more than 800,000 Americans live in assisted living facilities. Families that are fortunate enough to have long-term care insurance coverage generally expect to be able to use it to pay the exorbitant costs associated with their residence in these assisted living facilities or their caregiving. However, even despite having insurance coverage that should cover them, some insureds come to learn a very hard lesson when their claims get denied.

The reasons our Nevada long-term care insurance denial lawyer sees that these claims get denied are endless. The Law Office of Matthew L. Sharp can help you if your recently filed claim was rejected.

Who Has Long-Term Insurance Coverage?

Those who have long-term insurance are from all different age groups and secure coverage in case they fall ill or get hurt in unexpected accidents. However, an overwhelming majority of those with such coverage are older people who purchase such insurance to protect them as cognitive impairment or disabilities inevitably start to set in.

Individuals who have long-term insurance do so as a further protective measure to ensure that they’re not financially devastated by their assisted living or at-home care costs if a situation arises in which they need it. The more limited income that a person has, the more likely that they’d be unable to afford this type of caregiving if they needed it, or that a denial would financially devastate them.

How Much Do Insurance Companies Spend on Long-Term Care Annually?

Data published by the American Association for Long-Term Care Insurance (AALTICI) shows that insurers paid $13.25 billion for their members’ care in 2022. That marked a nearly $1 billion increase over the $12.3 billion spent one year earlier in 2021.

The point of highlighting these insurance companies’ annual payouts on long-term care is that costs are constantly increasing. While insurers adjust premiums members owe to coincide with the increase in expenses, it doesn’t take away from the fact an insurance company is a business that places significant value on profits. It, therefore, shouldn’t come as a surprise that one of the primary reasons why long-term care insurers deny claims is to avoid having to pay high costs.

Why Long-Term Care Insurance Claim Denials Occur

While costs are certainly a factor that may result in an insurer denying a claim, they’re not likely to list that reasoning on a denial letter they may send you in the mail. Instead, they’re more likely than not to mention one of the other common reasons these rejections occur, including:

• There were missed insurance premium payments: You may not have been covered during the time you were housed in a rehab facility or nursing home or received in-home care because you failed to make timely payments and, thus, your policy was canceled.
• An insured requested payment on a claim for uncoverable services: Long-term care insurance companies have selected services they pay for and under specific circumstances. They tend to deny claims for personal care and other services, as outlined in policy documents.
• Inadequate supporting documentation was provided: Insurance companies often require documentation proving claim eligibility. If you provide insufficient records to support the claim, the insurer may reject it.
• A claims reviewer reaches an incorrect decision about your eligibility: Insurance companies hire assessors who regularly review claims to ensure that they’re only covering individuals whose long-term care is absolutely necessary. An insured or their medical provider may understate the extent of their health concerns, resulting in a denial of a claim and future benefits.
• A prior confinement provision applies: Insurance companies will often place prior confinement provisions in a nursing home or rehabilitation facility, or in home caregiving contracts. Those clauses generally require an insured to be hospitalized or to have been housed at an assisted living facility previously to be eligible to receive long-term care benefits. These are unlawful in many jurisdictions.

When Your Long-Term Care Insurance Claim Gets Denied

Take time to request a letter from your insurance company outlining the reason for their denial if you haven’t received this already. This will better assist our legal team at the Law Office of Matthew L. Sharp in determining how to proceed in your case. It can also be helpful for you to bring any policy documents you have to this free case evaluation, as this paperwork will generally outline the legal remedies the insurer requires you to follow when an insurance dispute arises.

As for that latter point, that insurance policy may require you to see the appeals process through to completion before you’re able to take any type of legal action, including filing a civil lawsuit.

Should concerns persist and it seems like your long-term insurance carrier is intent on not playing fair, perhaps because they are slow to re-review your claim or they continue requesting additional evidence to support it, their conduct may rise to the level of bad faith insurance practices. A long-term care insurance denial lawyer can help you in preparing your case for a lawsuit and eventual trial in such situations if necessary.