Everyone is at risk of requiring a long-term care system if they become sick, sustain a permanent or long-term injury, develop issues with cognition, or face frailty due to the aging process. When these challenges prevent someone from performing daily living activities like basic tasks like dressing, eating, and using the toilet–without assistance, the individual needs long-term care in the form of health-care, residential care, or community service-provided care. When you are choosing your health insurance plan, you must go through the conditions that qualify for LTD.
How insurers deny insurance claims of long-term disability
When long-term care is ultimately needed, the insurance companies deny claims wrongly, leaving the insured individual and their loved ones to struggle to provide care and financial support because heal insurance does not provide sufficient coverage.
Insurers that sell long-term care policies are more motivated by business ideas than the best interest in reviewing the claims. Ultimately, they look for ways to deny the claims to gain higher profits. Long-term care services are expensive, and benefits are needed to pay annually. The important thing is to understand that the long-term care policy is an enforceable contract where the carrier promises to provide long-term care benefits with agreeable policy terms and conditions.
The draft policy language is not helpful to the insured parties.
The policy terms and language are designed intentionally in a confusing, unnecessarily complicated, and ambiguous manner so claimants do not submit the information required for claim approval. Another way to deny a claim is by asserting that the policy prevents coverage because:
- The claimant did not provide enough evidence to prove they cannot accomplish at least two of the daily living activities.
Insurers determine claim decisions based on written disability proof. They need information on medical records, physician’s narrative reports, pharmacy prescriptions, employment history, etc., to determine long-term disability status.
- The policy does not accept pre-existing medical conditions.
Long-term disability policies usually do not pay benefits for disability contributed to, caused by, or related to a pre-existing condition.
- The condition is not covered.
The long-term disability plans do not cover every disability. Few provide coverage for specific conditions listed in the schedule of benefits.
- The independent medical examiner denied your disability.
If your insurer doubts your disability length or extent, they will visit a non-treating physician for an independent medical exam. But the IME is generally a biased procedure.