AZ Long Term Care Insurance Denials Lawyer 

Erin

Hi, I’m Erin

My life’s calling is to hold insurance companies accountable for the promises they make.

Our law firm focuses exclusively on Arizona disability benefits law and we’d love to help you out.

Were Your Long Term Care Benefits Denied? Our AZ Long Term Care Insurance Denials Attorneys Are Here to Help You

If an insurance company wrongfully denies your long-term care benefits, an AZ long term care insurance denials lawyer can help. So don’t give up on pursuing the benefits that you deserve and need.

You paid the premiums for the policy in the unfortunate event you ever needed it due to chronic illness, injury, or aging. If the insurance company refuses to honor their end of the contract, let our law firm help you. Read below for all the details you need if you face a long term care benefits denial.

What Is Long-Term Care Insurance?

Long-term care insurance (LTC) will help pay for:

  • Nursing home care
  • Assisted living
  • Adult daycare services
  • Home health care
  • Home modifications
  • Care coordination services

The Two Main Types of LTC Policies: What You Need to Know

There are two main types of LTC policies, and some policies blend both: indemnity and reimbursement.

Indemnity policies pay you a set amount as a daily benefit, regardless of the actual cost of your case. 

Indemnity policies are similar to cash benefit policies, which also pay a particular benefit amount per day. Reimbursement policies pay up to a certain daily benefit limit depending on the cost of your care. 

If your care costs more than that daily benefit amount, you will pay the additional cost of your care.

We can review your LTC policy to explain your coverage.

LTC plans were more prevalent in previous decades. Few insurance providers offer LTC plans nowadays because they cost insurance companies so much money. 

Now that insurers understand the costs of their LTC plans, we are seeing an increased number of LTC benefit denials.

If an insurer denies your LTC benefits, contact us. We can help. Never walk away from your rightful benefits without consulting our attorneys.

AZ Long Term Care Insurance Denials FAQs

How Can an AZ Long Term Care Insurance Denials Lawyer Help Me Get My Long-Term Care Benefits?

Every LTC policy is different, but generally, to receive LTC benefits, you have to prove that you suffer from cognitive impairment or need assistance with two (2) or more of six (6) primary Activities of Daily Living (ADLs).

What Are Activities of Daily Living (ADLs)?

ADLs are activities that every person needs to do independently to live independently:

 

  • Hygiene, which includes bathing and general grooming necessities.
  • Dressing, which includes being able to appropriately dress and undress oneself.
  • Eating, which includes having the ability to feed oneself, but not necessarily the ability to prepare food for oneself.
  • Transferring, which includes the ability to move between standing and sitting positions, get in and out of bed, and walk independently between locations.
  • Toileting, which includes the ability to get on and off the toilet. This differs from continence, or the ability to control one’s bladder and bowels.

 

If you consistently struggle to perform two or more of these ADLs without assistance, you may qualify for LTC benefits.

Why Were My Long-Term Care Benefits Denied?

Even if you meet the criteria to receive LTC benefits, the insurance company may deny them for unsubstantiated or inaccurate reasons to save money.

 

To deny your LTC benefits, the insurance company may:

  • Dispute that you actually need assistance with the ADLs that you cited.
  • Dispute that you have a cognitive impairment severe enough to warrant LTC benefits.
  • Allege that you didn’t pay your premiums, either on time or at all, which could disqualify you from receiving your benefits.
  • Assert that the company providing your care services doesn’t qualify under your plan.
  • Cite a gatekeeper provision, which older LTC policies may contain. Gatekeeper provisions require you to have had a hospital stay, nursing home confinement, or both before paying your claim.
  • Claim that your medical condition has either improved, is not severe enough, or is excluded entirely under your policy.
  • Procure conflicting medical opinions regarding your medical condition or disability.
  • Conduct surveillance on your claim and use surveillance or social media posts as a misleading reason to deny benefits.
What Does a Long Term Care Policy Not Cover?

A long-term care (LTC) policy may contain exclusions and limitations:

  • Pre-Existing Conditions
    Many LTC policies exclude coverage for conditions you had before purchasing the policy. For example, if doctors already diagnosed you with a chronic disease like Alzheimer’s before the coverage started, your benefits might not apply for related care.
  • Self-Inflicted Injuries
    Long-term care policies generally do not cover care resulting from intentional harm or self-inflicted injuries.
  • Certain Medical Conditions
    Some policies exclude coverage for specific illnesses or disorders, such as mental health conditions not classified as organic brain disorders (e.g., depression or anxiety). Let us review your policy carefully to tell you which conditions it won’t cover.
  • Family-Provided Care
    Unless explicitly stated, many LTC policies do not reimburse for care provided by family members, even if they serve as your primary caregivers.
  • Non-Qualified Facilities or Services
    LTC policies typically require you to use licensed facilities or certified care providers. If you seek care through an unlicensed caregiver or facility, the policy may not cover the costs.
  • Care Outside Policy Limits
    If you exceed the coverage limits outlined in your policy, such as daily benefit caps or maximum payout amounts, the policy may not cover the additional expenses.

If you’re unsure about your policy’s specifics, our attorneys can clarify your coverage to help you manage expectations and plan your long-term care needs.

Why Do Long-Term Disability Benefits Claims Get Denied?

Insurers deny long-term disability (LTD) claims for various reasons:

  • Insufficient Medical Evidence
    Insurance companies require extensive proof that your condition prevents you from working. If your application lacks detailed medical records, test results, or physician statements, insurers may deny the claim, stating you haven’t proven your disability.
  • Failure to Meet Policy Terms
    LTD policies often have strict definitions of what qualifies as a disability. For example, some policies define disability as being unable to perform any occupation, while others cover only an inability to perform your own occupation. Misunderstanding or failing to meet these criteria can result in a denial.
  • Pre-Existing Condition Exclusions
    Claims may be denied if the insurer determines your disability stems from a pre-existing condition, particularly if the condition was diagnosed or treated before the policy coverage began.
  • Missed Deadlines
    LTD claims have tight filing deadlines. Missing these deadlines can jeopardize your claim, even if it’s valid. Similarly, failing to adhere to appeal deadlines after an initial denial may prevent you from pursuing further action.
  • Insurance Company Tactics
    Insurers often utilize tactics to minimize payouts, such as misinterpreting policy terms, downplaying medical evidence, or relying on biased medical experts. For example, they may hire third-party physicians to conduct Independent Medical Examinations (IMEs) that favor the insurer’s interests.
  • Insufficient Documentation of Work Limitation
    LTD claims require not only medical evidence but also proof that your condition directly impacts your ability to perform essential job functions. Without clear documentation of how your condition limits your work, insurers may deny your claim.
  • Surveillance or Social Media
    Insurers sometimes conduct surveillance or review social media posts to argue that claimants aren’t as disabled as they claim. For example, if an individual is seen engaging in certain physical activities, insurers may use this evidence to challenge the validity of their claim, even if those activities don’t contradict the medical condition.

Our AZ long term care insurance denials attorneys can address these denial reasons by gathering compelling evidence, ensuring deadlines are met, and holding insurers accountable for unfair practices.

If your claim is denied, don’t lose hope – appealing with legal support gives you the best chance of success.

Are Long-Term Care Premiums Tax Deductible?

Whether or not you can claim long-term care (LTC) premiums as tax deductions depends on your age, medical expenses, and filing status.

Here’s an overview of when and how LTC premiums may qualify for a tax deduction:

  • Qualifying Premiums
    Premiums paid on a tax-qualified LTC insurance policy can be added to your total medical expenses for tax purposes. A tax-qualified policy must meet certain standards set by the Internal Revenue Code, such as requiring a health professional’s certification that you need substantial assistance with daily activities.
  • The Medical Expenses Threshold
    To deduct LTC premiums, your total medical expenses must exceed a certain percentage of your adjusted gross income (AGI).
  • Age-Based Deduction Limits
    The IRS limits the amount of LTC premiums you can deduct based on your age. These limits are adjusted annually. For example, older taxpayers often qualify for a higher deduction cap because they’re more likely to incur significant medical expenses.
  • Self-Employment Considerations
    If you’re self-employed, you may deduct LTC premiums even if you don’t itemize deductions. The IRS caps this deduction at the age-based limit but allows you to reduce your taxable income directly.
  • Caregiver Rules
    If you pay LTC premiums for a spouse, dependent, or parent, and you cover at least half of their support, you may be able to include their premiums in your medical expenses for tax deductions.
Long-Term Care Insurance Lawyers Arizona

Don’t Give Up: Talk to an AZ Long Term Care Insurance Denials Lawyer Today

You paid the premiums for the policy in the unfortunate event you ever needed it.

 

The laws surrounding LTC policies and the coverage itself can be complicated – contact the experienced AZ long term care insurance denials lawyers at Sandstone Law Firm today at (602) 615-0050 and let us take care of this unfortunate situation for you.

Marc M. | 2021
Five Star

The perfect choice! I’m so pleased that I choose Erin and her team to represent me. She had everything I was looking for in a disability attorney: professional, knowledgeable, respectful, caring and passionate about her work. She was always on point and nothing got passed her! Her team is equally qualified and efficient! 100% no reservations I would recommend her and her team!

T-Scott
Scott D. | Flagstaff – 2018

Erin Ronstadt was my LTD attorney. She is very knowledgeable on Employee Plans and the ERISA law. She was very easy to work with, compassionate and understanding. She kept me informed on the status of my case and kept me updated on the next steps. She did an awesome job winning my case and got me much more than expected.

Marshall S. | Tempe – 2018

Erin Ronstadt is a competent and caring attorney and we are pleased with our settlement. We felt very comfortable working with Erin and her assistant, we would not hesitate to work with her again.

T-Darly
Daryl S. | Sedona – 2018

Unfortunately life happens and sometimes we have to hire an attorney. Erin and her staff have made an uncomfortable situation more tolerable. The entire staff has worked hard on our behalf and made us feel included and heard along the way.

Michelle – 2019

Five Star

“Erin and her team were the shining light in this otherwise extremely long and difficult experience.”

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Robert I. | 2021

I’ve worked with hundreds of attorneys over the past 30 years and Erin and her team (Merry) are truly excellent. Professional, knowledgable, responsive and so very pleasant.

T-Ray

Ray M. | Finisterre – 2017

I had a great experience with this firm. Everyone here is extremely courteous, kind, and professional. My attorney, Erin Ronstadt is very knowledgeable and truly cares about her clients. She has done a terrific job with my case and I would highly recommend her for anyone that needs representation!

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Erika B. | Mesa – 2017

I highly recommend Erin Ronstadt if you need help with your disability case. Erin was very knowledgeable and compassionate. I knew I was in good hands after our consultation. Her advice led to a successful outcome for us. If there were more than 5 stars I would give them.

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Bob S. | Surprise – 2014

Did a great job on my case——-we WON in court!

Sandstone Law Group

Our long-term care insurance lawyers know how to fight insurance companies.

Case evaluations are 100% free and you are under no obligation to hire our law firm. We will vigorously represent you and not back down to insurance companies.

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