How to Handle Delays in Long-Term Care Insurance Claim Processing

Long-term care insurance provides financial support for individuals who need assistance with daily living activities due to aging, illness, or disability. However, one of the policyholders’ biggest frustrations is dealing with claims processing delays. These delays can create financial strain and uncertainty, especially when care is urgently needed.

If your long-term care insurance claim takes too long, here’s what our nationwide claims attorneys at Disability Insurance Law Group suggest you can do to address the issue and protect your rights.

Why Are Long-Term Care Insurance Claims Delayed?

Insurance companies often delay processing claims for several reasons, including:

• Missing or Incomplete Documentation – Insurers may claim that required medical records, care provider information, or policy details are incomplete.
• Excessive Review Procedures – Some insurers prolong the review process by repeatedly requesting additional information.
• Waiting Periods – Many long-term care policies include an “elimination period,” requiring policyholders to pay out-of-pocket care for a set time before benefits begin.
• Disputes Over Policy Coverage – The insurer may argue that the needed care type is not covered under the policy terms.
• Deliberate Delay Tactics – Some companies intentionally slow the process to avoid payouts or discourage claimants from pursuing benefits.

Steps to Address Long-Term Care Claim Delays

If your claim is stuck in processing, prompt action can help resolve the issue and move things forward.

• Review Your Policy Carefully

Start by thoroughly reviewing your long-term care insurance policy.

Pay attention to:

• Covered services and exclusions.
• Benefit limits and daily maximums.
• Any waiting period that applies.
• Documentation requirements for claims.

Understanding your policy’s terms can help you determine whether the delay is legitimate or an attempt to avoid paying benefits.

• Follow Up with the Insurance Company Regularly

Stay proactive by maintaining regular contact with your insurer.

• Call the claims department and ask for a status update.
• Request specific details on what is causing the delay.
• Take notes during each call, including the representative’s name and the conversation date.

If you get vague responses or repeated requests for more paperwork, it may be a sign that the insurer is intentionally stalling.

• Provide Any Missing Information Promptly

If the insurer claims your documentation is incomplete, request a detailed list of what is missing. Work with your healthcare providers or facility to submit any additional records as quickly as possible.

• Keep Copies of All Communications and Documents

Maintain a detailed record of all claim-related interactions, including:

• Letters and emails from the insurance company.
• Copies of submitted medical records and forms.
• Notes from phone conversations.

This documentation can be valuable evidence if you need to escalate your claim.

• File a Complaint with State Insurance Regulators

If your insurer continues to delay your claim unfairly, you can file a complaint with your state’s Department of Insurance. Many states have consumer protection laws that require insurers to process claims within a reasonable timeframe.

Seek Legal Assistance if Necessary

If your claim remains delayed or is wrongfully denied, working with an experienced disability insurance attorney can make a significant difference.

An attorney can:

• Hold the insurance company accountable for bad-faith delays.
• Ensure all necessary documentation is submitted correctly.
• Take legal action if required to secure your benefits.

We Can Help Expedite Your Long-Term Care Insurance Claim

Delays in long-term care insurance claim processing can be frustrating and financially devastating, but you don’t have to handle it alone. At Disability Insurance Law Group, we help policyholders nationwide fight unfair insurance tactics and get the benefits they deserve. If your claim is stuck in limbo, contact our national insurance claims attorneys at 954-989-9000 or online today to discuss your options and take action.

Related Links:

• A Short Term Disability Denial Or Determination Delay Does Not Preclude A Claim For Long Term Disability Benefits
• Common Delay Or Denial Tactics Utilized By Life Insurance Companies
• Unfair Disability Insurance Claim Denials: How to Take Legal Action Against Your Insurer