Long-Term Care Insurance Denial in Fort Lauderdale

The Aging of America – Increased Demand for Long Term Care Policies


FJW insuranceUncertain economic times combined with an aging population have created a greater demand for long term care insurance. According to U.S. Census Bureau data, the median age in America has been rising and the last of the 76 million Baby Boomers will reach age 65 by 2030—doubling the elderly population in America. The U.S. Department of Health and Human Services estimates that about 40% of people aged 65 or older have at least a 50% lifetime risk of entering a nursing home. Today about 8 million Americans own long-term-care insurance, which helps cover the cost of home health care, nursing homes and assisted-living facilities, among other things.

Long-term care insurance is a hedge against unpredictability in life’s circumstances—especially as we get older. Chronic illness or disability is not always predictable. Long-term care insurance sometimes covers expenses not covered by Medicare. Often consumers purchase this type of insurance decades in advance, thinking it will help pay the costs for care that they’ll need later in life. Long-term care insurance is in part meant to provide consumers peace of mind that they will not become financial burdens to their families or exhaust their life savings if at some point they need assistance with the basic activities of daily living.

Long-term care insurance is highly regulated in some, but not all states. As part of that regulation, long-term care insurance policies and insurance carriers must comply with certain specific requirements. Some of these regulations may prohibit certain types of exclusions or require that certain benefits be provided without certain conditions. Unfortunately, most consumers are not aware of their legal rights under long-term care rules and statutes. If they are denied benefits, they simply take the insurance company’s “word for it” and find themselves saddled with enormous costs of care.

Has Your Long-Term Care Insurance Claim Been Denied?

Of course, not all denials of insurance benefits are incorrect. However, your insurance company should be very clear about the reasons why your claim has been denied. If it does not specify why your claim was denied; ask for a written explanation detailing the reasons for the denial.

Common Unjustifiable Reasons for Denial

FJW LongTermCareA few of the ways insurance companies may deny your claim illegitimately include:

  • Denying benefits because a care provider or facility does not meet certain criteria stated in the policy when the criteria are unlawful under state regulations.
  • Ignoring changes in state law on long-term care insurance which outlaw certain types of policy conditions and provisions.
  • Failing to apply annual percentage increases in benefits properly.
  • Misinterpreting separately covered incidents or events as one continuous incident or event.
  • Requiring that care providers have certifications or licensures which are not required under state law for the level of care provided.
  • Not following on-site or in-person evaluations of the basic activities of daily living (ADLs) (dressing, bathing, eating, toileting, continence, transferring (getting in and out of a bed or chair), and walking).

We Represent People Who Have Long-Term Care Insurance Policies

Farmer, Jaffe Weissing, Edwards, Fistos & Lehrman, P.L. has represented clients who have been unfairly denied by long term care insurance providers, and/or conducted investigations of providers, including:

  • American Pioneer
  • Bankers Life
  • CNA
  • Transamerica
  • Caring People
  • Guarantee Life Insurance
  • John Hancock
  • Washington National

Seek Justice – Demand Experienced Legal Representation

Attorneys Steven Jaffe and Mark Fistos of Farmer, Jaffe, Weissing, Edwards, Fistos & Lehrman, P.L., help and represent individuals who have been unfairly denied their long-term care and home health care insurance benefits. They can respond to a denial of benefits or a lack of response; negotiate lump sum settlements; and file a lawsuit when necessary. They provide free initial evaluations of an insurance claim or policy.

If you have information or concerns about an insurance company’s long term health insurance practices or coverage of assisted living facilities, contact Steve Jaffe or Mark Fistos at (954) 524-2820 or for additional information visit www.pathtojustice.com.

Free Initial Legal Consultation – and We Aren’t Paid unless there is a Recovery

Our consultations with potential clients are free and confidential. If we take your case, we are only paid fees and costs of suit if we succeed in winning a recovery for you. In most situations, if your case is won, attorney’s fees are paid by the insurance company who denied the client coverage.