Genworth Long-Term Care Insurance Claims Attorney

Long-Term Care Insurance Denials and How We Can Help

Long-term care (LTC) insurance is designed to cover costs for those needing assistance with daily activities or supervision due to cognitive impairments. However, policyholders often face challenges with Genworth Long-Term Care Insurance denials when seeking benefits. At Pillsbury & Coleman, LLP, we recognize the frustration and financial strain caused by denied claims. Our experienced attorneys are dedicated to helping you challenge unfair denials, navigate the appeals process, and, if necessary, pursue lawsuits to secure the coverage you’ve paid for over years of premiums.

When Should Your Long-Term Care Claim Be Approved?

LTC insurance policies outline specific criteria for claim approval. Typically, coverage is triggered when a policyholder cannot perform at least two of six Activities of Daily Living (ADLs) without assistance, such as bathing, dressing, eating, toileting, transferring, or maintaining continence. Claims may also be approved for cognitive impairments, like dementia or Alzheimer’s, requiring supervision for safety. For example, a policyholder with a progressive condition like Alzheimer’s should qualify if medical records confirm their care needs. Policies often include an elimination period—a waiting period before benefits begin—which must be met. Understanding these criteria is critical, as insurers may exploit vague policy language to deny valid claims, necessitating legal intervention.

Why Are Long-Term Care Claims Denied?

Policyholders frequently encounter issues with Genworth Long-Term Care Insurance appeals due to the insurer’s strict claim evaluations. Denials can arise for several reasons, including:

• Insufficient Documentation: The insurer may claim that medical records or care plans do not adequately prove eligibility for benefits.
• Disputes Over ADLs: Genworth might argue that the policyholder can still perform certain daily activities independently, despite contrary evidence.
• Cognitive Impairment Challenges: Claims may be rejected if the insurer deems a condition, like dementia, insufficiently severe or if the policyholder refuses cognitive testing due to anxiety.
• Lapsed Policies: Missed premium payments, often due to administrative errors or unaffordable rate hikes, as seen in lawsuits like Skochin v. Genworth, can lead to policy lapses.
• Non-Qualifying Care Providers: Benefits may be denied if care is received from unlicensed providers or facilities not meeting policy standards.

These denials often stem from overly strict interpretations or procedural errors, which our attorneys can challenge through appeals or litigation.

How Can Our Attorneys Assist with Your Long-Term Care Claim?

At Pillsbury & Coleman, LLP, our skilled Genworth Long-Term Care Insurance denial lawyers have extensive experience addressing needs. We thoroughly review your policy to confirm coverage entitlements and identify errors in the denial process. Our team gathers critical evidence, such as updated medical records and physician statements, to strengthen your claim. We craft compelling appeals that directly address the insurer’s reasons for denial, ensuring compliance with policy terms. If an appeal fails, we are prepared to escalate the matter through litigation, leveraging our expertise in insurance bad faith lawsuits to hold insurers accountable. Our attorneys understand the high stakes of denials and are committed to securing your financial and care needs.

Resolving Disputes Over Lapsed Policies

Lapsed policies are a common issue in LTC denials, often tied to premium payment disputes. Policyholders may miss payments due to administrative errors, such as outdated contact information, or unaffordable premium increases, as highlighted in cases like Haney v. Genworth. Our attorneys investigate the lapse, examining whether proper notification procedures were followed or if the lapse resulted from insurer errors. We work to reinstate policies or recover benefits by proving bad faith practices, such as failing to notify secondary contacts. When reinstatement isn’t possible, we pursue settlements to compensate for lost coverage, ensuring you receive the support you planned for.

Steps to Take After a Long-Term Care Claim Denial

If your LTC claim is denied, prompt action is essential due to tight appeal deadlines. Here are the key steps to take:

• Review the Denial Letter: Carefully read the denial letter to understand the specific reasons for rejection.
• Gather Documentation: Collect all relevant documents, including medical records, care plans, and correspondence, to support your claim.
• File an Appeal: Submit an appeal within the deadline (typically 60–180 days), addressing each denial reason with clear evidence.
• Consult an Attorney: Engage an experienced lawyer to guide you through the appeal process and strengthen your case with expert arguments.
• Consider Litigation: If the appeal is denied, evaluate filing a lawsuit, as denial practices have been successfully challenged in court.
• File a Complaint: Report unfair practices to your state’s insurance commissioner for further investigation.

Contact a Genworth Long-Term Care Insurance Attorney Today

At Pillsbury & Coleman, LLP, we assist at every step, from evidence collection to litigation. Contact us at (415) 433-8000 for a free consultation to explore your options.

Lawsuits like Halcom v. Genworth highlight issues like inadequate disclosures about premium hikes, underscoring the need for skilled legal representation. At Pillsbury & Coleman, LLP, we fearlessly challenge major insurers to ensure your needs are met. Let us help you secure the long-term care benefits you’ve earned.