News Release, May 7, 2008, by National Association of Insurance Commissioners (NAIC), announced a settlement reached by State insurance regulators in several States with one of the largest U.S. long-term care insurers, Conseco. The settlement required Conseco to pay a $2.3 million fine and make $30 million in claims-handling improvements and restitution because of an alleged pattern of wrongful delays and denials of coverage. This case illustrates that some long-term care insurers may deliberately deny claims on the smallest of pretexts, and make it difficult to collect on your claim unless you dot every “I” and cross every “t” – and maybe even if you do.
Note to Caregivers: HelpingYouCare.com strongly recommends that you read the insurance policy fine print before your loved one purchases a policy and again before submitting a claim, and that you obtain appropriate legal help with these processes. Be clear about the policy’s claims and coverage requirements – particularly those pertaining to Activities of Daily Living (“ADL’s”). Many are not aware that long-term care insurance policies often exclude coverage unless you obtain a certification both from your doctor and from the assisted living facility or care provider that the insured person needed actual “assistance” (more than just “supervision”) with two or more (or perhaps more) ADL’s during the period covered by the claim. A common ground for denial of claims is failure to check a sufficient number of ADL boxes in the claim form and/or failure to submit the required certifications as to needed assistance with the required number of ADL’s. Caregivers should become knowledgeable about the terms of your loved one’s long-term care insurance policy. After all, if your loved one needs assistance with two or more ADL’s, chances are he or she may not be able properly to fill out the claim forms and chase down the signatures, as required. Inattention to required details in submitting claim forms can result in unnecessary denial of claims, followed by excessive delays in attempting to correct mistakes.