Dedicated Long-Term Health Care Attorneys Serving Tampa, FL
We are very fortunate to have the world-class Johnny Byrd Alzheimer facility in Tampa, and people travel from across the country to be seen by their physicians. Hopefully, you or your loved one is covered under a long-term health care policy that assists with activities of daily living (ADLs) because of physical and/or cognitive impairment. If you need assistance or have questions regarding your policy, contact our Tampa long-term health care lawyer today.
The Benefit Trigger in a Cognitive Impairment or Dementia Long-Term Care Claim
There are common benefits triggers in a long-term care policy and, while not are all the same, common benefit triggers are:
Significant or severe cognitive impairment,
An inability to perform two or three acts of daily living as defined by the policy.
How are the terms “significant cognitive impairment” or “severe cognitive impairment” defined in your policy or that of a loved one? While every policy is different, one common definition is:
“A severe cognitive impairment is where the insured has a severe deterioration and/or loss of cognitive capacity that results in the need for substantial supervision, as defined below, by another person to protect his/herself or others from threats to health or safety. Cognitive impairment of this severity must be evidenced by global impairment of activities of daily living as demonstrated by standard neurocognitive testing.
Examples of conditions that might result in severe cognitive impairment include, but are not limited to the following:
Moderate to severe Alzheimer’s disease,
Severe traumatic brain injury,
Severe cerebral vascular accident.
Substantial supervision is the continual supervision by another person to protect the insured or others from threats to safety (such as results from wandering) when the insured has a severe cognitive impairment. Such supervision may include cueing by verbal prompting, gestures or other similar demonstrations.”
That definition can be proof of a nightmare. The policy attempts to pigeonhole the nature of the dementia, demands a level of proof with ill-defined or undefined terms, demands certain findings on neuropsychological testing, and more that can confuse and disorient someone. The way this is written gives the long-term health care insurance carrier the ability to define and apply terms that will allow them to justify a claim denial or termination. Our Tampa long-term health care attorneys are here to help you if you are struggling with your policy and are in need of our expertise. Don’t go through this alone.
How A Tampa Long-Term Health Care Lawyer At Cavey Law Can Help
Before a claim for long term care benefits is filed, regardless of whether it is for physical or cognitive impairment, you should consult with the skilled attorneys at Cavey Law. We can review the policy, explain the terms of the policy and what must be proven, review the medical records, and develop and implement a winning strategy. In the case of a cognitive impairment claim, we can review any neuropsychological testing for proof issues, help you obtain winning neuropsychological testing, have a home health assessment, obtain lay and family statements about the nature of the impairment and progression, shoot “a day in the life” video, and have a physician endorse the testing, the home assessment and any video. This strategy will help improve the chances of success when filing a claim and keeping those benefits. Don’t forget that the carrier will do a continuing review, so this is not a one and done strategy and will take consistent work. It takes teamwork with Cavey Law, and your Tampa long-term health care is here to help. Contact us today at 727-287-5704.