Long-Term Care Insurance Denials for Mental Illness
Mental illness can make everyday life unmanageable, often requiring long-term care services like residential treatment, in-home support, or ongoing therapy. These services are expensive, and if you’ve paid into a long-term care insurance policy, you expect coverage when you need it most. Unfortunately, insurance providers often deny or delay valid mental health claims to avoid payouts. At Dawson & Rosenthal, P.C., we hold insurance companies accountable when they act in bad faith. If your insurer is denying long-term care benefits for mental illness, our Arizona insurance law attorneys are ready to fight for your rights.
When Long-Term Care Coverage Should Apply
Mental health conditions can significantly limit your ability to perform daily activities like bathing, dressing, or managing medications. Long-term care insurance is supposed to provide financial support for services that help you maintain basic quality of life when mental illness becomes disabling. Covered services may include:
- Inpatient psychiatric care or residential treatment
- Skilled nursing or memory care for conditions like severe depression or schizophrenia
- In-home mental health care or support
- Extended outpatient therapy beyond traditional limits
Whether you’re managing a lifelong condition or a new diagnosis with sudden deterioration, long-term care insurance should respond, provided your policy includes mental health coverage.
Common Mental Illnesses That May Qualify
Insurance companies often try to narrow coverage by limiting benefits for mental health conditions, especially those that don’t have physical symptoms. However, many long-term care policies do cover mental illness when it prevents independent living. Some commonly covered conditions include:
- Major depressive disorder
- Generalized anxiety disorder
- PTSD
- Bipolar disorder
- Schizophrenia and other psychotic disorders
- Alzheimer’s and other cognitive impairments
That said, insurance providers may try to cap benefits at 24 months or exclude coverage entirely through vague or outdated policy terms.
Why Claims for Mental Illness Get Denied
Mental illness claims often face more scrutiny than physical ones. Here’s how insurers deny valid claims:
- Ambiguity in policy terms: Many policies contain unclear language about mental health coverage, leaving room for denial.
- Lack of physical evidence: Unlike physical injuries, mental illness often doesn’t come with labs or scans, making it easier for insurers to dispute severity.
- Pre-existing condition clauses: Providers may argue that a condition existed before policy coverage began, even if treatment wasn’t previously needed.
- Insufficient documentation: If records don’t clearly show that your condition limits daily function, your claim may be rejected.
How to Strengthen Your Long-Term Care Claim
To counter insurance denials, build a rock-solid claim. Here’s how:
- Detailed documentation: Make sure your providers record how your mental health condition affects daily living activities. This is critical for showing eligibility.
- Ongoing treatment: Most insurers require evidence that you’re under continuous medical or psychiatric care.
- Policy review: Understand the exact terms of your long-term care policy, especially around benefit duration, exclusions, and waiting periods.
- Legal help: Don’t wait for multiple denials. A long-term care insurance attorney can help file a strong initial claim or appeal a wrongful denial.
Red Flags for Bad Faith Denials
If your insurer uses stalling tactics or denies your claim without justification, you may be dealing with bad faith. Look for signs like:
- Unexplained delays in communication or decisions
- Shifting reasons for denial
- Pressuring you to settle or sign away rights
- Ignoring medical documentation or independent evaluations
These tactics are illegal, and our legal team knows how to fight back.
Get Help with a Long-Term Care Insurance Denial for Mental Illness
You’ve paid premiums expecting protection, and you deserve that support when mental illness requires long-term care. If your insurance provider is denying benefits, contact Dawson & Rosenthal, P.C. We’ve spent decades holding insurers accountable in California and Arizona. Let us help you get the care you need and the benefits you’re owed.