Long-Term Care Insurance Denials for Cancer Patients

Surviving cancer is only part of the battle. Even after treatment, many individuals need ongoing support that long-term care (LTC) insurance is supposed to cover, such as home health aides, nursing facilities, or assisted living. Unfortunately, insurance companies often delay, underpay, or outright deny these claims. At Dawson & Rosenthal, P.C., our long-term care insurance attorneys help cancer patients and their families navigate the challenges of claim denials and insurance bad faith in California and Arizona.

Why Cancer Patients File Long-Term Care Insurance Claims

Cancer can leave lasting physical and cognitive effects, and treatment itself often leads to serious impairments. These conditions can make daily tasks unmanageable without outside help. Long-term care insurance is designed to pay for these services when an illness, like cancer, requires extended care beyond what health insurance covers. Whether you need help with bathing, dressing, mobility, or supervision due to treatment-related complications, a long-term care insurance claim may help offset these overwhelming costs. Filing a claim should mean access to coverage for care, but insurance companies frequently put roadblocks in the way.

Are You Eligible for Long-Term Care Benefits?

Whether your LTC policy was purchased individually or provided through an employer-sponsored plan, eligibility for benefits depends on the language of your policy. Cancer patients may qualify based on:

• Type and stage of cancer
• Severity of symptoms and treatment side effects
• Loss of ability to perform Activities of Daily Living (ADLs)
• Cognitive impairment
• Age and overall medical history

A long-term care insurance attorney can help you review your policy, document your impairments, and file a claim that clearly aligns with your coverage terms. If your claim has already been denied, we can help identify the insurer’s rationale, and build a strong appeal.

Long-Term Care Benefits Available to Cancer Patients

If your claim is approved, LTC benefits can provide critical support, especially when cancer prevents you from living independently. Benefits may include:

• In-home care: Payment for home health aides or personal attendants
• Nursing home or assisted living care: Coverage for residential facilities that provide 24/7 care
• Rehabilitation services: Physical, occupational, or speech therapy during recovery
• Respite care: Temporary relief for family members or caregivers
• Care coordination: Case managers or care coordinators to help manage your plan

If your loved one passed away from cancer and was covered by an LTC policy, you may also be eligible for survivor or death benefits depending on the policy terms.

Common Issues with Long-Term Care Insurance Denials

Sadly, insurance companies often deny legitimate claims by relying on technicalities or vague policy interpretations. If you’re facing a denial, it’s not the end of the road, you have legal options. Challenges we frequently see in cancer-related LTC claims include:

• Policy misinterpretation: Insurers may claim your impairments don’t meet the “benefit trigger” requirements, even when you clearly qualify.
• Documentation issues: Incomplete or unclear medical records may be used to justify a denial.
• Delays and stonewalling: Some insurers drag their feet in hopes claimants will give up or settle for less.
• Bad faith tactics: Insurance companies may misrepresent coverage, demand unnecessary documentation, or mislead claimants about their rights.

We step in to confront these practices, push back against denials, and demand accountability.

How to File a Long-Term Care Insurance Claim for Cancer

The claim process can be time-consuming and emotionally draining, especially while dealing with cancer recovery. Here’s a general outline of what to expect:

1. Notify your insurer about your intent to file a claim.
2. Request claim forms and review your policy to understand coverage and exclusions.
3. Gather medical records and proof of your cancer diagnosis, treatment, and resulting limitations.
4. Document ADL impairments or cognitive conditions with support from your care providers.
5. Submit the application with supporting documents, keep copies of everything.
6. If denied, file a timely appeal and include any additional evidence requested.

An LTC attorney can manage this process for you, ensuring deadlines are met and your claim is presented with the strongest possible documentation.

Talk to a Long-Term Care Insurance Attorney in California or Arizona

The attorneys at Dawson & Rosenthal, P.C. understand how devastating it is to face a claim denial when you or a loved one is already fighting cancer. With over 70 years of combined experience handling insurance bad faith and LTC claim disputes, we know how to hold insurers accountable. If your long-term care claim has been denied, delayed, or underpaid, contact our San Diego office today to speak with a lawyer who can help you get the benefits you’ve earned.