Common Mistakes That Can Hurt Your Long-Term Care Claim Appeal
Receiving a long-term care claim denial does not end your opportunity to appeal and receive benefits. However, attending to these common mistakes that can hurt your long-term care claim appeal is pivotal to getting the financial help you need. Avoid these and other mistakes by working with our Phoenix long-term care insurance lawyers representing clients in Arizona and Southern California.
Failing to Document Your Claim Adequately
Thorough documentation is essential to receiving approval of a claim. Without evidence to prove a disability or health condition, an insurer and the medical and occupational professionals providing opinions on your disability cannot accurately assess your medical needs and limitations. The first step in appealing a long-term care insurance denial is gathering missing documentation to support an appeal.
Not Understanding the Reason for a Claim Denial Before Submitting an Appeal
Understanding why an insurer denies your claim is vital to filing an appeal. The insurer must give a written response to your claim explaining the reasons for your long-term care claim’s denial. Understanding the basis for a denial allows you to provide documentation to support an appeal and claim approval. An insurer will decide your long-term care claim based on the opinions of nurses, doctors, and occupational consultants. Professionals giving their views on your claim without sufficient evidence can misinterpret your condition, prognosis, and ability to perform occupational duties and daily tasks. Understanding the reason for a claim denial may spotlight common tactics used by insurance companies to deny LTD claims.
Failing to Review a Long-Term Care Policy and Claim File Before Submitting an Appeal
Reviewing your policy will provide crucial information about the policy terms you must satisfy before being awarded benefits. You must prove that the disability or medical condition prevents you from performing basic daily tasks. Your policy should explain what an insurer expects from you to prove that long-term care is necessary. Any documentation you provide about a disability or medical condition, and the documentation obtained by your insurer from medical and occupational professionals rendering opinions about a disability or illness, and long-term care are also in your claim file. Reviewing your case file allows a long-term care insurance lawyer to assess the information an insurer uses to make a disability determination and may shed light on signs your long-term care claim was denied in bad faith.
Not Responding to New Evidence That Becomes Available After Submitting an Appeal
An amendment to ERISA claims regulations requires insurers to provide participants with new evidence they base a determination on after the participant submits an appeal. New evidence can provide missing information to a doctor independently reviewing your case, impacting the outcome of an appeal. You may request additional time to respond before filing an appeal. Making the case for approving an appeal becomes stronger when you can prove that a medical professional lacked clarifying information about your disability in an initial assessment and ruling.
Missing an Appeal Deadline
You typically have 180 days from a claim’s denial date to appeal the decision. National emergencies have extended this timeframe in the past. Always consult with your long-term care insurance lawyer to prevent missing an appeal’s deadline.
Waiting to Work With a Long-Term Care Insurance Lawyer
Securing legal representation may help you avoid common mistakes that can hurt your long-term care appeal. Working with a long-term care lawyer before filing a claim may help prevent a denial. An experienced Phoenix bad faith insurance lawyer of our firm can help you navigate the complexities of filing a long-term care claim and appealing a denial.