Everlake (Allstate) Long-Term Care Denials Attorney
Hi, we’re Erin & Kyle
Our mission is to hold insurance companies accountable for the promises they make.
At our firm, we focus exclusively on helping people with long-term disability benefit issues and long-term care insurance denials. We’d love to help you get the benefits you deserve.
When Allstate sold its long-term care (LTC) insurance closed block to Everlake Life Insurance Company, thousands of policyholders were impacted. LifeCare Assurance Company has also been used as a third party claims administrator, so you may not know who is handling your claim at the end of the day – Everlake, Allstate, LifeCare, or some other entity.
At Sandstone Law Group, we push back. Our team helps people respond when Everlake (formerly Allstate) says “no” to what we view as a valid long-term care (LTC) claim. If you’re dealing with a denial, an Everlake long-term care denials attorney at our firm can help you understand your options and take action.
In this article, you’ll find general answers to many key questions. For actual legal advice and guidance about your situation, please contact us for a free consultation. We’ll review your denial, explain your rights and options, and do all we can to help.
What Is Everlake Long-Term Care Insurance?
Everlake took over Allstate’s long-term care insurance policies in a move that may have caught many policyholders off guard. This shift involved transferring responsibility for older long-term care plans, many of which were written years or even decades ago.
From Allstate to Everlake
Allstate sold long-term care policies for years before deciding to exit that line of business. Everlake acquired those existing policies and assumed claim responsibilities. The change wasn’t optional for policyholders—they were moved over automatically.
How Everlake Has Handled the Transition
Policyholders didn’t ask for a change in insurer, but Everlake now controls these legacy policies. Since the transition, some people have noted delays, confusing communications, and what they perceive as unfair denials. These experiences have led to uncertainty for families who were relying on these benefits.
What LTC Insurance Covers
Long-term care (LTC) insurance helps pay for services that assist people who can’t perform everyday activities on their own due to aging, illness, or disability. These activities—often called Activities of Daily Living (ADLs)—typically include bathing, dressing, eating, using the toilet, transferring (like getting in and out of a bed or chair), and continence.
Here’s what long-term care insurance usually covers:
1. In-Home Care
Many policies include services performed right in the person’s home. This might involve:
- Home health aides to help with bathing, grooming, and dressing
- Skilled nursing for wound care or injections
- Therapy services like physical, occupational, or speech therapy
- Homemaker services (sometimes covered), such as help with cooking and cleaning
2. Assisted Living Facilities
Coverage may apply to residential communities that provide help with daily activities along with housing, meals, and limited medical care. These facilities have become more sophisticated over the last few decades, and now many offer 24/7 medical supervision and direct assistance with all activities of daily living.
3. Nursing Homes
Nursing Homes can often include more intensive care than other facilities for those that need continuous nursing services, but do not require hospital care or daily care from a physician. Nursing Homes can include services such as:
- Inpatient beds
- 24/7 medical supervision and skilled nursing care
- Assistance with all activities of daily living
- Rehabilitation services
4. Memory Care Units
For people with Alzheimer’s disease or other forms of dementia, policies often cover specialized memory care provided in secure settings.
5. Adult Day Care
Some policies include daytime programs that offer supervision, meals, and social activities while caregivers are at work or need a break.
6. Hospice and Palliative Care
If a person is in the final stages of a serious illness, long-term care insurance may help pay for comfort-focused care, either at home or in a facility.
Limitations to Be Aware Of
Even when services fall under these categories, coverage isn’t automatic. Policies may require:
- A licensed provider (like a certified home health agency)
- A doctor’s statement confirming the person needs help with at least two ADLs
- An elimination period (like a deductible period in days) before benefits start
- Daily or lifetime caps on how much the policy will pay
If you’re dealing with a claim denial, these coverage details become even more important. Insurers may argue about whether the provider or facility qualifies or whether care truly meets the policy terms. When that happens, having a legal team like Sandstone Law Group can make a big difference in getting those benefits paid.
What Rights Do Policyholders Have When Facing a Long-Term Care Denial from Everlake or Allstate?
Even if your claim was denied, you’re not powerless. State and federal laws give you options. You have the right to challenge the denial and hold the company accountable.
Legal Protections for Policyholders
Several legal tools support your right to fair treatment:
- State Insurance Laws: Every state regulates how insurance companies operate, including how they handle claims.
- Bad Faith Laws: Insurers that act dishonestly or unfairly may face penalties under “bad faith” statutes.
- Contract Law: Your long-term care policy is a binding agreement. If the company breaks it, you may have grounds for legal action.
- Statute of Limitations: There’s often a deadline for challenging a denial. Missing it can close the door, so acting quickly matters.
How Can an Attorney Help With Your Everlake or Allstate LTC Denial?
When Everlake denies a long-term care (LTC) insurance claim, it can leave families scrambling. Bills pile up and care plans fall apart, sometimes with limited explanation from the insurer. That’s where an attorney can step in. At Sandstone Law Group, we help policyholders fight back, cut through red tape, and work toward securing the benefits they paid for.
Legal Strategies We Employ
1. Reviewing the Fine Print
Policies are full of detailed language that controls what’s covered and what’s not. We read every word—then use it to your advantage. Our team looks for:
- Ambiguities that benefit the policyholder
- Contractual duties the insurer didn’t meet
- Clauses that support your right to benefits
Many denials crumble under close legal scrutiny. We know how to make the case when the insurer is relying on weak or inconsistent reasoning.
2. Building Strong Evidence
A denial isn’t always the end—it’s sometimes the start of fighting for your benefits. We help gather everything needed to push back, including:
- Updated medical records
- Letters from doctors and care staff
- Proof of policy compliance
- Written statements outlining daily care needs
By organizing these materials into a focused package, we reduce the insurer’s ability to stall or avoid action.
3. Negotiating With the Insurer
We take the fight directly to Everlake. We can present a full, documented case showing:
- Why the denial is wrong
- The care that’s been provided
- The harm caused by the delay
Our firm speaks their language and uses it to demand better outcomes for our clients.
4. Filing Suit if Needed
If Everlake won’t reverse the denial or offer a fair settlement, we will go to court. Our team prepares the case thoroughly and pursues every legal avenue. This may include claims for:
- Breach of contract
- Bad faith insurance conduct
- Statutory penalties or interest
Litigation holds the insurer publicly accountable and often leads to faster, more complete resolutions.
Why Legal Help Matters
Dealing with an long-term care (LTC) denial takes time, energy, and experience. Most families are already stretched thin caring for a loved one. Legal help:
- Levels the playing field with the insurer
- Saves time by managing paperwork and calls
- Strengthens your position through detailed legal arguments
- Increases the odds of a faster, better result
At Sandstone Law Group, we know how these companies operate, and we know how to respond.
What Should You Do If Your Everlake or Allstate Long-Term Care Claim Is Denied?
Start by gathering all the facts. Understand why the claim was denied, collect every document tied to your care, and keep a record of everything the insurer says or does. These steps set the foundation for a strong legal case.
1. Save Every Piece of Paperwork
Hold on to every letter, form, and email you’ve received from Everlake. This includes:
- The denial letter
- Any explanation of benefits (EOBs)
- Prior approvals or care assessments
Make digital copies, too. If the insurance company changes its story later, you’ll have a paper trail to prove what they said and when.
2. Keep Following the Care Plan
Even after a denial, continue with the recommended care—if at all possible. Stopping treatment or care could give the insurer more excuses to deny future claims. Stick to your doctor’s orders, document the services received, and collect receipts for all out-of-pocket payments.
3. Request a Full Written Explanation
Insurers must explain the reason for denying your claim. If the denial letter is vague or doesn’t clearly say why the claim was rejected, request a detailed written explanation. You’re entitled to know the exact reason and what part of the policy the insurer says supports their decision.
4. Log Every Interaction
Start a notebook or digital log. Record every phone call, email, or letter. Note the names of people you speak with, the date and time, and what was discussed. This can come in handy if the insurer gives conflicting information or fails to follow through on promises.
Building Your Case
Strong evidence supports your side and keeps the insurer accountable.
1. Gather Medical Records
Request up-to-date medical records from your doctors and care providers. Be sure they reflect the specific needs that qualify for benefits under your policy—such as needing help with two or more activities of daily living (ADLs) or having a cognitive impairment.
2. Collect Statements from Care Providers
Ask nurses, aides, and physicians to write statements that explain the care being provided and why it’s necessary. These written accounts carry weight during reviews and appeals, especially when backed by licensed professionals.
3. Build a Timeline
Create a clear timeline showing:
- When the claim was submitted
- When and how the denial was received
- The steps taken after denial (appeals, calls, letters)
- The course of care (what services were provided and when)
This timeline tells your story and helps uncover any delays or errors in how the insurer handled the claim.
4. Consider Expert Opinions
Sometimes, an independent nurse consultant, physician, or policy analyst can review your claim and provide insights. Their input can highlight flaws in the insurer’s reasoning and support your case. This is a step that Sandstone Law Group can aid you in.
Contact Our LTC Claim Denial Attorneys Now
At Sandstone Law Group, we stand with policyholders. When Everlake denies claims unfairly, we act. We’ve helped clients get the care benefits they deserve, and we’re ready to help you too.
Don’t wait for deadlines to run out. For a free consultation and assistance with the process, reach out to Sandstone Law Group today by calling 602-615-0050. Our team of long-term care insurance claim denials lawyers is ready to review your case, answer your questions, and stand up for your rights as a long-term care policyholder.