Esteemed Long-Term Health Care Attorneys Serving St. Petersburg, FL
You or a family member bought a long-term care insurance policy to provide financial assistance and peace of mind if you or they became unable to do basic activities of daily living because of physical impairment and/or cognitive impairment. You or a covered loved one might be impaired because of an injury from an accident or slip and fall or from a progressive medical condition like fibromyalgia, POTS, multiple sclerosis, Parkinson’s, or COVID complication. Worse yet, you or a covered loved one might have a cognitive impairment as a result of Alzheimer’s, a traumatic brain injury, or even a stroke. If that has happened to you or a covered loved one in the St. Petersburg area or the long-term care policy was issued in Florida, you should call the St. Petersburg long-term health care lawyer at Cavey Law.
What Every Long-Term Care Policyholder Must Know About The Terms “Activities of Daily Living” in Their Policy
You or your loved one bought a long-term care policy to provide assistance doing Activities of Daily Living because you or they did not want to be a burden on the family.
But what types of activity were you thinking about when you or a loved one bought the policy? Bathing, dressing, eating, toileting, and transferring are all basic activities (ADLs) that can be impacted by a physical and/or cognitive impairment. But is that what is covered under the terms of the policy? The right answer is found in the policy.
There are two issues to consider as you review the policy:
How does your policy define the term Activities of Living?
How many ADLs must you be unable to perform to qualify for long-term care benefits?
Many policies require that you be unable to do certain types of ALDs and require that you be unable to do a certain number of ADLs as a precondition to paying benefits. Remember you have the burden of proving your entitlement to long-term care benefits. You must know the terms of your policy and what you have to prove before you file a claim or appeal a wrongful denial or termination. If you need help to understand your policy, contact our St. Petersburg long-term health care attorneys.
Physical Impairment and ADLs
How does the physical impairment impact the ability to do ADLs? What do the medical records say about the need for care and what about your physical examination or diagnostic studies support your entitlement to getting benefits?
Proving physical or cognitive impairment is crucial. You or your loved one probable bought a long term care policy to cover the costs of care for assistance with ADLs in:
a nursing home,
adult day care,
an assisted living facility or
a rehabilitation facility.
What do you or your loved one have to prove to get or be reimbursed for care at any of these facilities? Finding out now and before you file a claim or appeal a wrongful denial or termination should be your first step and our St. Petersburg long-term health care attorney can help.
Cognitive Impairment, ADLS and Long-Term Care Benefits
What type of cognitive impairment and how severe must it be to qualify for long term care benefits? The answer is both in the policy and your or your loved one’s medical records.
The common policy benefit triggers for long term care benefits for cognitive impairment are:
A significant cognitive impairment, and
An inability to perform two or three ADLs, as defined in the policy.
How does the policy define “significant cognitive impairment”? A common definition is a “deficiency in a person’s short term or long term memory, deficiencies in orientation to person, place and time, deficiency in deductive or abstract reasoning or judgment that impact’s the policy holder’s safety.” What does that mean practically and medically?
Did you or your loved one have to be seen at The Johnny Byrd Alzheimer facility or by a family doctor? Do you or your loved one have to undergo a brain MRI or neurocognitive testing? How do you explain what assistance is needed? Does your doctor have to certify the type of assistance that is needed and the appropriate facility?
Lots of questions, and our St. Petersburg long-term health care lawyers have answers!
How A St. Petersburg 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. Knowledge is power and you need all the power you can get! Better yet, to avoid any surprises and to create a strategic plan for when and how to file a claim, call us at Cavey Law 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. We will want to review all the medical records, particularly if the claim for benefits is as a result of cognitive impairment so we clearly understand the nature of the impairment and can formulate a battle plan.
Once a claim has been filed that is based on cognitive impairment,
the carrier will schedule an interview. Don’t be surprised if your loved one denies any cognitive impairment or problem with ADLs.
the carrier will demand neurocognitive testing and will want the raw score data so they can have it reviewed by their liar for hire neuropsychologist.
the carrier liar for hire neuropsychologist will disagree with everything your physician and neuropsychologist has to say.
the carrier doesn’t speak with family members about memory or behavioral issues and the progression of the cognitive impairment.
If the long-term care insurance carrier is playing the delay, we want more information, deny or delay game, it is time to call St. Petersburg long-term health care lawyer at 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.