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Dawson and Rosenthal
Dawson and Rosenthal

San Diego Long-Term Care Insurance Bad Faith

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 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 step in to protect the consumer.

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 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.