Our firm works routinely with clients on questions and issues related to long-term care insurance.
You or a loved one may have purchased long-term care insurance coverage anticipating that it will be available should the need arise. Typically, long-term care policies provide coverage where health insurance does not, most commonly for expenses such as nursing home stays, assisted living, in-home care, and adult day care.
Given the high and rising costs of long-term care, accessing available insurance can be especially important, and disputes often arise pertaining to the existence, scope, terms, conditions, and limitations contained in any potentially available long-term care insurance policy.
For instance the “elimination period” in a long-term care policy mimics a “deductible,” in that the policies generally provide coverage only after the insured pays on his or her own for the defined number of days. The duration of a policy’s elimination period affects policy pricing – i.e., a longer elimination period will translate to a lower premium cost.
Coverage under a long-term care policy is typically “triggered” based upon the insured’s inability to perform a defined group of “Activities of Daily Living” (ADLs) such as dressing, eating, and bathing.
Some policies may provide “inflation protection” that increases the available benefit over time to account for rising costs. Other consideration include coverage associated with cognitive impairment, premium suspensions upon payment of benefits, and coverage for necessary home modifications.
As with any insurance matter, all terms and conditions of potentially relevant coverage should be considered in view of applicable state law when determining the available and scope of coverage. These issues can be stressful and difficult for any family with a loved one requiring long-term care.
Our attorneys are experienced insurance and long-term care insurance attorneys. We have litigated long-term care insurance coverage matters and have numerous individual and insurer clients on planning and coverage issues associated with long-term care insurance.
This content is provided as background and does not constitute legal advice. For more information or to schedule a free consultation, contact us at info@lalorattorneys.com / 646.818.9870.
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