AZ Long Term Care Insurance Denials Lawyer 

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.

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.

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.

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.

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.