Long Term Care (“LTC”) insurance has been and will continue to be a heavily disputed practice area. Policyholders, many of whom have paid premiums for years, only now are beginning to make claims. Plaintiffs’ counsel are notorious for making inflammatory allegations that insurers prey on vulnerable senior citizens in marketing, premium-setting and rate increases, claims and coverage decisions, and lapsing policies for late premium payments. Claimants, specifically elderly policyholders who paid premiums for many years before filing claims, are especially sympathetic.
The intricacies involved with LTC policies require prompt investigation and efficient resolution of claims and lawsuits. Our firm provides expertise in the following areas of LTC claims on behalf of insurers:
- Coverage Opinions to assist the insurer resolve coverage disputes;
- Analysis of Policy Provisions in Long-Term Care Insurance Policies;
- Complete representation from the initiation of a Long-Term Insurance claim through any potential litigation and appeals;
- Management of claim investigations, denials and settlement of disputed claims;
- Investigation of fraud or misrepresentation on behalf of any insureds or their providers, including litigation related to the same;
- Defense of claims made through alleged assignments of benefits; and
- Initiation of Declaratory Judgment actions to have the Courts determine rights, status and other equitable or legal relations between parties.
We understand that individuals with LTC policies may be sympathetic individuals and we treat each case with the diplomacy it deserves. We also understand that an insurance policy is a contract, with its terms, conditions and exclusions representing bargained-for terms to manage risks. Our goal is to ensure that the insurer pays only what is required under the terms and conditions of a claimant’s insurance contract.