Disability Insurance Claims
Long-Term Care Insurance Claims

Many different kinds of long-term care insurance policies exist, and there are many different ways in which insurance companies attempt to deny long-term care insurance claims. Of course, not every kind of policy or claim denial can be discussed on this website, so we encourage you to give us a call to discuss anything and everything pertaining to long-term care insurance. That said, however, here are a few examples of the many things one must keep in mind when it comes to long-term care insurance.

Long-term care insurance claim denials often parse insurance policy words. For example, although an insured may be receiving services at an assisted living facility identical to those he or she would receive at a nursing home, and although the policy covers such services when provided at a nursing home, the claim may be denied because the treatment center is technically dubbed an assisted living facility. Or vice versa. Such semantics-related denials are often case-by-case and heavily dependent on policy language. The Merlin Law Group, with its extensive experience in conducting detailed analysis of facts and policy language, can assist.

Long-term care claims are also commonly denied based on the insurance company’s contention that you are not cognitively impaired, you have not lost functional capacity (or the ability to engage in the activities of daily living), and / or your treatment is not medically necessary. These kinds of denials are also very fact-intensive and / or policy-intensive. Regarding the facts, sometimes expert opinion is required. The Merlin Law Group has the skill sets and the resources needed to assist you with a cognitive impairment, functional capacity, and / or medical necessity denial.

 

Long-Term Care Insurance Claim Articles

Long Term Care Insurance Claim Denial

By Jeffrey L. Greyber, Esq.

 
Long-Term Care Providers Billing Problems

By Jeffrey L. Greyber, Esq.

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Merlin Law Group represents not only long-term care policyholders, but any long term care faciliy, nursing home, or assisted living facility that has an assignment of benefits from the policyholders. When your patient may be struggling mentally or physically it may be easier for our attorneys to work with the facility rather then the policyholder.

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Combating Carrier Delay

By Jeffrey L. Greyber, Esq.

All too often, potential clients find themselves dealing with insurance company foot dragging.  The most common example of foot dragging is the insurance company’s taking an inordinate amount of time to provide the policyholder with the most simple of documents, the policy.  Well, what to do about that?  No need for me to reinvent the wheel … here is an article entitled Claim Delay 101 that I published in December 2013: 

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Is Your Treatment or Care Medically Necessary?

By Jeffrey L. Greyber, Esq.

In the health insurance and long-term care insurance arenas, an all-too-common basis for claim denial is that the subject treatment or care was not medically necessary. “Medical necessity” is an amorphous concept, for several reasons. Perhaps the most obvious reason is that treatment plans often account for the individual just as much (if not more) than the diagnosis; i.e., a particular kind of treatment may be necessary for one of two patients presenting with the same condition, but not for the other.

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2014 Florida Conference On Aging

By Jeffrey L. Greyber, Esq.

Last week, my colleague and I attended the 2014 Florida Conference On Aging in Weston, Florida. We were there, with our booth and handouts, representing the Merlin Law Group’s disability, life, health, and long-term care insurances practice.

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Long-Term Care Insurance Claims, ALF vs. Nursing Home

By Jeffrey L. Greyber, Esq.

There is much to be assessed when exploring long-term care insurance options, particularly the decision of choosing an assisted living facility or a nursing home. The fundamental differences between an assisted living facility and a nursing home are the level of care that a resident receives as well as the amount of freedom allotted to a resident.

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The Location of Your Long-Term Care Can Be Make-or-Break

By Jeffrey L. Greyber, Esq.

Regardless of the kind of insurance claim at issue, the wording of the insurance policy is indispensable to the coverage analysis, and many insurance companies will strive to avoid coverage by parsing policy words. To illustrate this point and contemporaneously caution those interested in procuring long-term care insurance, I now discuss the dogmatic interpretation and application of long-term care insurance policy language regarding the location of care.

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Get Back To School - Long-Term Care Insurance 101

By Jeffrey L. Greyber, Esq.

Many folks I speak with are unaware of the existence of long-term care insurance. I have found that the folks who are aware of the existence of long-term care insurance know precious little about same. So, today’s blog offers any and all such folks a legislative / legal overview and a practical considerations overview of long-term care insurance.

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