What are some general issues I may confront with a long term care claim?


Video Transcription


All policies are different and they’re going to have different provisions. You want to understand your policy. First, how long is your coverage for? Do you get six months of coverage? Do you get two years of coverage? Depending on how long you get, also is it renewable? Do you get that period of coverage when the policy’s over or can you renew that coverage after some period of not using the benefits? Very, very key and important to know about your policy. Next, what triggers your policy? Typically, you have a requirement to meet so many activities of daily living. In other words, things like bathing, toileting, being able to dress yourself. Most of the policies will require that you have to require help, hands on assistance, with two or three of these things. The next issue that can trigger your policy is whether you have mental incapacity or dementia. You want to make sure you look at your policy terms and make sure that your medical providers are properly documenting your issues over time so you can prove or demonstrate that you’ve met the terms of the policy. Again, the key thing is to make sure you or somebody assisting you has reviewed your policy, talked to your health care providers. When hiring people to help treat you though, like a home health agent or a home health nurse, you want to make sure that your policy doesn’t require they be approved. If they are approved, get them pre-approved or you can run up big bills and not get compensation for them. If you have any questions or you’re not sure you understand all the terms or requirements of your policy, reach out to an attorney that has experience handling long-term care claims.

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