So you have paid your annual premiums for Long Term Care for 30 years. Now you need to collect. You are managing your parents’ account and you need to place a parent in an assisted living facility. Thank goodness you purchased long term care.
The long-term care policy your parent purchased was written in a time when the basic long term care needs that your parent anticipated was nursing home, hospice, or home health care. Assisted Living facilities were new. But, Assisted Living Facilities have their own license through the state, provide round the clock nursing care, keep charts, require physician’s orders for admission, etc., so surely they are covered, right?
Many insurance companies like to hold you to that original agreement. And since it does not name “assisted living facilities” then they are not covered. None of the other facts matter. It doesn’t matter that when you purchased the policy you wanted coverage for whatever facility you would be required to live in (other than your home) that would cost extra. You bought the policy with those thoughts in mind. When the agent told you to add the endorsement for home health care, you did it to cover all your bases. But now, after paying $5000/year for over 30 years, the insurance company is denying your benefit. You get no value for that investment – no return – no dividend – nothing. The insurance company got the luxury of investing those funds for the last three decades and you get nothing.
Maybe you were denied for another reason than this. In any event, please contact our firm as we are looking for cases to take against insurance companies who are doing this. It is wrong. Insurance companies are supposed to put your interest on even terms with theirs – they are a fiduciary to you. We welcome the opportunity to see if they have kept their end of the promise they sold to you or your loved ones.