San Jose Long Term Care Insurance Claims Lawyer

Skilled Long Term Care Insurance Claims Attorneys Serving San Jose, CA

If you are like many people, you may have invested in a long-term care policy for the day when you might require the assistance of that vital care. Although long-term care insurance can be a valuable resource for many people, the insurance is only as good as the benefits you get when you need it. If you have counted on your long-term care insurance to be there for you and have been wrongly denied, we can help. At Pillsbury & Coleman, LLC, our skilled San Jose long-term care insurance claims lawyers have spent three decades advocating for individual’s rights when they are unfairly denied benefits.

The Increasing Expense Of Long-Term Care

It is estimated that nearly 70 million Americans will be over the age of 65 by 2030, and many will need assistance paying for their care. Long-term care gets more expensive each year, with the average annual cost of care as of 2020 coming in at $137,240 here in California. Consequently, more older adults are counting on long-term insurance to supplement their costs at this critical time.

Those who purchase these policies do so trusting that they will be able to take advantage of benefits when the time comes for their needed care. Unfortunately, for many, they find out the reality of an industry that is more concerned with profits than their policyholders. If you have made a claim for long-term care benefits and have been denied, you are not alone.

What Does Your Policy Cover?

In the state of California, there are three types of long-term care insurance that are offered. It’s important to keep in mind what type of coverage you have and what benefits this entitles you to.

• Nursing facility and residential care facility coverage covers skilled, intermediate, or custodial care in an institutional setting such as a nursing home, assisted care facility, or other residential care facilities. These policies do not cover home care.
• Home care coverage covers home health care, adult daycare, personal care, homemaker service, hospice services, and respite care. Care in a facility is not covered.
• Comprehensive long-term care must include nursing home benefits, residential care facilities, home health care, adult day care, personal care, homemaker services, hospice, and respite care.

We can help you understand your policy and what you can expect in the way of benefits.

Insurance And Profits

As for-profit entities, insurance companies strive to keep costs low by denying benefits. As skilled San Jose long term care insurance claims lawyers, we know this is an unfortunate truth throughout much of the industry. Keeping benefits from you keeps money in their pockets. They do this by adeptly finding reasons to deny claims and use many different tactics and excuses to do this. The most common of these include:

• Ineligible facility — A nursing home or other long-term care facility must be eligible care providers for that insurance company. An insurance company may claim that the facility is not eligible under their policy. Insurance companies will often require that a facility meet criteria even if that criteria was not set out in the policy. In this case, you may be able to challenge the denial.
• No prior hospitalization — This is sometimes referred to as a “gatekeeper provision” that required a policyholder to have been confined to a hospital or nursing home before benefits were paid in older policies. Most states no longer recognize these provisions, yet that doesn’t stop companies from trying to enforce them.
• No personal care benefits — An insurer may refuse benefits for what they call “personal care,” but you may challenge this if you meet a policy’s ADL (Activities of Daily Living) requirements. Many policies may also exclude care that is provided by the insured’s family members as specified in the policy, but you may also be able to work around this.
• Nonpayment because of cognitive impairment — sometimes an elderly individual has not paid premiums due to a cognitive impairment, but in most cases, there is a 5-month period before a policy can lapse due to unpaid premiums.

Getting The Assistance Of A Long-Term Care Insurance Claims Lawyer In San Jose

If you are having difficulty getting benefits under your long-term care policy, call the experienced San Jose long term care insurance claims lawyers at Pillsbury & Coleman, LLC. We have dedicated our practice to holding the insurance industry accountable to their policyholders. Contact us today to discuss your claim and see how we can help.