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Dawson and Rosenthal
Dawson and Rosenthal

San Diego Long-Term Disability Claim Attorney

According to the National Health Care Anti-Fraud Association, financial losses from health care fraud amount to tens of billions of dollars annually. Insurance companies aren’t nonprofits; their goal is to make money. When people suffer long-term health issues, insurers tend to focus on costs more than people. Unfortunately, this leads to issues of long-term care insurance bad faith. Long-term care is particularly susceptible to bad faith and fraud due to the length of the payout. If you or a loved one is suffering a long-term health crisis and the insurance company is working in bad faith, you need the help of an experienced San Diego long-term disability claim attorney.

According to the American Association for Long-Term Care Insurance, the older population will double in 2030 from where it was in 2000. An estimated 10 million Americans needed long-term care in 2000, and, considering the rise in the number of aging Americans, those stats will certainly rise in the next few years. With the growing number of adults who need care, insurance companies may work to avoid as many payments as possible.

What Is Long-Term Care Insurance?

Long-term care insurance covers services people need over an extended period. These services may happen in a home, at a facility in San Diego, or at a community organization. Long-term policies typically reimburse the policyholder a daily amount to cover the services necessary for daily life. These can include:

  • Dressing
  • Bathing
  • Using the bathroom
  • Eating
  • Getting out of bed

Of course, this is just a short list of daily needs. Ongoing issues could include medical intervention and prescription drugs. It is important to provide care for those who need it to avoid larger emergency situations.

Common Long-Term Care Insurance Policies

Most long-term care policies are comprehensive, meaning they cover services in a variety of settings. Comprehensive policies provide the most coverage for patients who need care from multiple sources and can provide extra protection if the covered parties need to make alternate arrangements. Care can happen daily in multiple locations or it may vary from week to week. These settings can include:

  • In-home care
  • Adult day service care facilities
  • Rehabilitation facilities
  • Respite care
  • Hospice care
  • Assisted living facilities
  • Alzheimer’s care facilities
  • Nursing home

Policies that cover specific locations of care can be less expensive if care only occurs at that one place. In-home policies only cover care given to a patient in his or her own home and may include physical therapy, occupational therapy, rehabilitation therapy, and general help with daily tasks. If a situation arises where care happens outside the home or outside the San Diego area, an in-home insurance policy will be null and void.

Long-Term Care Insurance and Bad Faith

Because long-term care lasts over an extended period, insurance companies sometimes tire of the hefty payout. This can result in a case of long-term insurance bad faith. When an insurance company does not hold up its end of the insurance policy, delaying payment or sometimes denying claims, insurance bad faith laws and a San Diego long-term disability claim lawyer step in to protect the consumer.

Examples of Bad Faith Practices in Long-Term Insurance Claims

Insurance carriers are not allowed to deny claims without just grounds. However, sometimes, the reasons a carrier gives for denying a claim are prime examples of bad faith insurance practices. Some of the most common bad faith insurance practices concerning long-term disability insurance claims include the following:

  • Ignoring substantial evidence proving you are disabled
  • Disregarding various financial and emotional hardships you continue to endure
  • Terminating benefits after not receiving or ignoring an update from a doctor appointed by the insurance carrier
  • Making low settlement offers or deducting operational costs from the settlement offer
  • Denying benefits for an unreasonable amount of time
  • Delaying, denying, or prolonging a settlement in an effort to pressure you financially so that you will accept a lower offer

Options of Long-Term Disability Insurance in California

There is an increasing number of Americans living with disabilities, and long-term disability insurance is a smart move so individuals to support themselves and their families in the event a disability does occur.

Long-term disability insurance plans can be incredibly beneficial. The state of California does have a short-term disability program in place that will pay a portion of a person’s wages for up to a year, but there is no state-sponsored long-term disability program. Other types of disability insurance, including SSDI and SSI, are very hard to qualify for.

There are some employer-provided long-term disability insurance policies available. Typical group long-term disability benefits will start after a person’s short-term disability benefits and sickly or exhausted. In general, long-term disability will cover approximately 60% of a person’s pay.

There are also various other types of private long-term disability insurance policies that can be taken out, and we strongly suggest that you analyze your options from multiple major insurance carriers when deciding which choice is best for you and your family.

How Can a Long-Term Disability Claim Attorney Help With My Denied Claim?

If your long-term care insurance claim has been denied in San Diego or anywhere else throughout this area, we want you to know that you have options. A skilled bad faith insurance attorney can get to work investigating every aspect of your claim in an effort to get the compensation you need into your bank account as soon as possible.

First, a bad faith insurance attorney will investigate your initial claim to make sure that everything looks appropriate. They will also thoroughly examine your insurance documents, including any contracts you have signed with the respective carrier. This will include working to show that your claim was wrongfully denied by the insurance carrier. A San Diego long-term disability claim attorney can use their resources to pressure the insurance carrier to accept the claim, and they will be fully prepared to take on the negligent insurance carrier in court. These cases can become confusing because they essentially involve multiple claims – your original insurance claim as well as the claim against the insurance carrier for a bad faith denial. This process can become confusing, but a skilled lawyer will be able to help you at each step along the way.

What to Do If You Suspect Bad Faith

If you suspect long-term insurance bad faith, a file a claim with the California Department of Insurance; such companies must follow both California state laws and federal laws. Some insurance claims can become lengthy and are full of technical jargon – often to confuse the customer. Hiring a bad faith insurance lawyer who specializes in long-term insurance bad faith means the company will be less likely to try and manipulate the insured. Having a professional on the case can lead to peace of mind and sometimes a larger settlement amount.

Find Legal Help for Long-Term Insurance Bad Faith

Long-term insurance bad faith can be a huge obstacle in getting family members necessary medical care. If you are dealing with a case of insurance bad faith, talk to one of our attorneys; we can help you discover if your insurer is treating you unfairly during a long-term health crisis.