Ensuring LTCI Fairness

Elder law attorneys and senior care advocates frequently remind community members of the value of long-term care insurance (LTCI). The New York legal professionals at our firm advise those who we are assisting with elder law estate planning of the immense value of having this insurance in place so that family assets are not decimated in the event (often likely) that skilled nursing home or at-home care is needed down the road. There are ways to save some assets without LTCI when Medicaid is used, but the best approach is always to have the necessary insurance.

When deciding on LTCI, however, it is critical that you understand the details of the policy and act to ensure it will work as desired when necessary. In fact, with the importance of this insurance increasing, many state are getting more invovled, offering more regulations and guidelines so that community members are protected from unfair practices where LTCI is at issue. A story last week by NY Now discussed the ways that some states are hoping to iron out some “kinks” in the system.

The main concern is ensuring that policyholders actually receive full and timely payments from the providers. Of course, having an insurance claim denied or not paid quickly can lead to serious repurcussions, because familes are forced to scramble to find alternative arrangements for necessary long-term care. Even if they are eventually vindicated, the delay in insurance coverage can cause significant financial (and emotional) damage that cannot be fully recuperated. To avoid that situation, some states are implementing more streamlined appeals processes, so that those who have claims denied or delayed can press for their rights more efficiently.

Oregon is leading the way it this effort, and some suspect that other states might follow suit. New legislation in Oregon now requires that all undisputed LTCI claims be paid within 30 days. The new state law also calls for more efficient appeals process for the policyholder with the state’s consumer services department. The underlying principle behind both of these efforts is an awareness of the unique damage that comes when a policyholder does not receive the compensation to which they are entitld.

One woman who was part of the effort to change the law in that state explained her frustration with the entire process following an LTCI dispute, noting “I just don’t know how older people can figure this stuff out, when it took me months and months and months.”

At the end of the day, New Yorkers should remember that LTCI remains a critical tool to protect their long term futures. Having the aid of a professional in the area can ensure that the LTCI fits within one’s overall estate planning efforts and will work as intended if the time comes.

See Our Related Blog Posts:

Elder Caregiving By Family Members

Life In An Assisted Living Facility

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