Long Term Care Insurance Claims

Long Term Care Insurance has been one of the fastest-growing types of insurance sold in recent years and many companies now offer Long Term Care policies.  These policies are typically purchased privately outside of the employment setting and are governed by state laws, which usually provide a broader array of damages for policyholders than do policies that are governed by the Employee Retirement Income Security Act (“ERISA”).  Regardless of your specific coverage, insurance companies have a financial incentive to collect premiums and pay out less in benefits, thereby increasing their profits.  This conflict of interest can motivate insurance companies to improperly deny your Long Term Care insurance claim.

Long Term Care Insurance Claims Denials

Typically, Long Term Care policies contain very technical language defining coverage for specific treatments and requirements for application.  Claimants must typically prove that they cannot perform a certain number of “Activities of Daily Living,” which typically mean any of the following:
  • Bathing:  Washing oneself by sponge bath; or in either a tub or shower, including the task of getting into or out of the tub or shower.
  • Dressing:  Putting on and taking off all items of clothing and any required braces, fasteners or artificial limbs.
  • Transferring:  Moving into or out of a bed, chair or wheelchair.
  • Toileting:  Getting to and from the toilet, getting on and off the toilet.
  • Continence:  Ability to maintain control of bowel and bladder function.
  • Eating:  Feeding oneself by getting food into the body from a receptacle or by feeding tube or intravenously.
What these terms mean and the standard of proof varies depending on the Long Term Care policy. These types of claims are similar to disability insurance claims, and often insurance companies will follow very similar practices in denying Long Term Care and disability insurance claims. These include taking medical evidence out of context, hiring biased doctors to evaluate claims, conducting an inadequate or biased investigation, using surveillance and other methods to assert that an insured does not qualify for long term care.  Moreover, insurance companies may continuously stall their determination process and/or require an unreasonable amount of documentation to establish entitlement to long term care benefits. 

Recovery and Damages for Long Term Care Insurance Bad Faith Claims Denials

California law imposes, on every insurance contract, the implied covenant of good faith and fair dealing, more commonly known as insurance bad faith.  If an insurer unreasonably and without proper cause denies an insurance claim by engaging in bad faith conduct, a policyholder may sue for policy benefits due under the policy, “consequential damages” that are caused by the bad faith conduct, emotional distress, punitive damages, attorneys’ fees and interest on past-due benefits (typically at the legal rate of 10%).  Long Term Care insurance policy denials are on the rise as companies seek to avoid losses.  

For more information, please see our Long-Term Care FAQs.

Long Term Care Insurance Bad Faith Claims Denial Experience

McKennon Law Group specializes in litigating and resolving Long Term Care, bad faith and ERISA insurance claim disputes for individual policyholders.  We have litigated and been consulted on hundreds of Long Term Care, ERISA insurance, disability insurance, life insurance, health insurance, bad faith and other insurance matters.  Because of our aggressive advocacy and our regional and national reputation as a leading California insurance litigation firm, we are able to achieve maximum settlements and judgments/verdicts at trial.

We have been litigating Long Term Care insurance, ERISA insurance, disability insurance, life insurance, property & casualty, bad faith and other insurance matters since 1986.  Our attorneys are nationally recognized experts in insurance bad faith litigation and have chaired numerous seminars and written numerous articles dealing with insurance bad faith claim issues.  Our attorneys are top rated by all major peer review rating agencies and have been honored to receive numerous prestigious awards and recognitions.  No attorneys in California or anywhere in the United States are better suited to litigate your Long Term Care insurance claim.  In fact, the attorneys of the McKennon Law Group previously represented the insurance companies that denied such claims and thus have the broadest possible experience in litigating these types of insurance disputes.  We can and will aggressively litigate your case to achieve maximum success.  We have significant trial experience and we are not afraid to go to trial against the big insurance companies.

Contact us to schedule a free initial consultation regarding your insurance claim or litigation matter.