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The fear of being a burden on your family or having to drain the family finances to provide care for yourself or your spouse is a real fear. It is a reality for many American families who struggle with providing care and who can’t afford to pay for care. That is why you, your spouse, or a loved one is wise to buy a long-term care policy and contact a Florida long-term health care lawyer. A long-term care insurance policy will help cover the cost of care when you or a family member have a chronic medical condition, disability or cognitive impairment as a result of one or a combination of medical conditions and can’t perform basic activities of daily living (ADLs).

Do you know what is in your policy? There are no uniform policies, and you can buy the coverage that you think you need. Unfortunately, when it comes time to file a claim you probably don’t know what you are entitled to and what you have to prove to get the benefits you or a loved one desperately need. That is why we are here to help you if you or a family member lives in Florida.

What Activities of Daily Living Are Covered Under a Long-Term Care Policy?

All long-term care policies have what is called a “benefit trigger.” Most long-term care policies will pay for or reimburse for benefits you or a family member paid when you or the covered family member can’t do at least two out of six activities of daily living.
Long-term care benefits are designed to assist with basic activities of daily living such as:

  • Bathing,
  • Caring for incontinence,
  • Dressing,
  • Eating,
  • Getting on and off the toilet, and
  • Getting in and out of bed or chair.

Once the benefit has been triggered, you or your covered loved has to file a claim and provide the necessary proof of entitlement to benefits. Often long-term health care policyholders are surprised to learn there may be a period of time that no benefits are paid, that you or they have to pay for benefits and then file for reimbursement, there are limits on how much is paid and for how long benefits are paid and even limits on the type of care and where the care is provided.

It is crucial that you or your covered loved one get out that long-term care policy they have been paying for and understand what is in the policy before filing a claim. Our Florida long-term health care attorneys can assist you. You don’t want any surprises, particularly after you have filed a claim and learn you have made so big mistakes in the claim.

Filing A Claim for Long-Term Care Benefits and The Games that Long-Term Care Insurance Companies Play When It Comes to Your Claim

Let’s be frank. Long term care insurance companies are not offering this coverage to provide them with peace of mind. That is why you or your loved one bought a policy and paid all those premium dollars. It is all about dollars! Long term care insurance companies offer this coverage and collect your gold. They are not necessarily in the business of paying benefits or continuing to pay benefits even when they have accepted the claim. They look for reasons to deny the initial claim for benefits or look for a reason each month to delay, deny or terminate benefits.

The long term care insurance company may deny or terminate benefits for a number of reasons:

  1. You or your covered loved one don’t need long term care benefits because your medical condition doesn’t really impact your ability to do ADLs.
  2. While you or your covered loved one might have some impairment that impacts your ability to do basic activities of daily living, you have problems performing two or more of the covered ADLs or have the right type of medical problems as required by the policy.
  3. You or your covered loved one’s doctor just hasn’t given us enough information or the right information to help us decide your entitlement to benefits, your continuing entitlement to benefits or the nature of the care you need.
  4. The people who are providing care or the location where you are getting care aren’t qualified under the terms of the policy or the services aren’t covered under the terms of the policy.
  5. Your medical condition has improved with treatment so you or your covered loved one no longer qualifies for benefits.

Ouch! That wasn’t what you or your covered loved one was thinking could happen. So, what’s next?

How Our Florida Long-Term Health Care Lawyer At Cavey Law Can Help

When you are or a covered loved begins to have physical, psychological or cognitive issues, it is time to get a copy of the long-term care policy and read it cover to cover. Better yet, to avoid any surprises and to create a strategic plan for when and how to file a claim, call our Florida long-term health care lawyers for a complimentary 30-minute consultation. We can review the policy, explain the terms and benefits, explain what you need to prove to submit a winning application, explain what the carrier can be expected to do with your claim and how to deal with delay and denial.

If long-term health care insurance carrier is playing the delay, we want more information, deny or delay game, it is time to call Florida long term care benefit law firm, Cavey Law.
We are here to help you or your loved one get the long-term care benefits that were paid for. We take the burden of dealing the long-term carrier off your shoulders. We make the long-term care insurance company keep the promises they made when you or your loved one bought the policy. Contact us at 727-287-5704 today.