Transamerica Long-Term Care Denials

Transamerica Life Insurance Company, part of the Netherlands-based Aegon conglomerate, manages long-term care policies for thousands of policyholders across the United States—though since 2019, your claim is actually processed by Long-Term Care Group (LTCG), a third-party administrator. Despite Transamerica's 100+ year history in the insurance business, the company has paid out nearly $300 million in settlements over the past decade for improper premium increases and questionable claims practices on universal life policies. Now, LTC policyholders are facing similar patterns: aggressive denial tactics, endless documentation demands, and a claims process designed to exhaust you into giving up.

At Sandstone Law Group, we represent many long-term care policyholders when Transamerica and LTCG prioritize cost containment over contractual obligations. Our comprehensive guide to LTCG's claim denials explains the added complexity of dealing with this third-party administrator, but the bottom line is this: you paid premiums for years—maybe decades—and you deserve the benefits Transamerica promised.

What Is Transamerica Long-Term Care Insurance?

Transamerica was founded in 1904, originally operating out of San Francisco—the city where its iconic pyramid-shaped building still stands. The company became part of Aegon, a Netherlands-based multinational insurance giant, in 1999. Today, Transamerica services one of the largest blocks of long-term care policies in the industry, with substantial policyholder populations in California, Arizona, and across the United States.

But here's what most policyholders don't realize: since 2019, Transamerica isn't actually handling your claim.

The 2019 LTCG Transfer

In 2019, Transamerica entered into an agreement transferring claims administration for its LTC insurance business to Long-Term Care Group (LTCG), which now operates under the parent company Illumifin. This means LTCG handles the entire lifecycle of your claim:

• Initial claim intake and documentation review
• Eligibility assessments based on Activities of Daily Living (ADLs) or cognitive impairment
• Care plan evaluation and approval
• Provider and facility verification
• Ongoing claim management and benefit payments

What this means for you: You're not just dealing with Transamerica's policies—you're navigating LTCG's processes, personnel, and documented tactics. You're facing two corporate entities whose interests align around one goal: limiting payouts.

For a complete breakdown of LTCG's specific denial tactics and their controversial history (including the CalPERS settlement and same-sex couple denial case), see our guide on LTCG denials.

When Your Benefits Should Trigger

Transamerica long-term care policies typically pay benefits when you're certified by a licensed healthcare practitioner as:

Unable to perform at least two Activities of Daily Living (ADLs) without substantial assistance for an expected period of at least 90 days. The six standard ADLs are:

• Bathing: Washing yourself, getting in/out of tub or shower
• Dressing: Putting on and taking off clothing, braces, or artificial limbs
• Eating: Getting food into your body from a plate, cup, or feeding tube
• Transferring: Moving safely into/out of bed, chair, or wheelchair
• Toileting: Getting to/from toilet, getting on/off toilet, associated hygiene
• Continence: Maintaining control of bowel and bladder function, or managing catheter/colostomy care

OR suffering from severe cognitive impairment that requires substantial supervision to protect you from threats to your health and safety—conditions like Alzheimer's disease or dementia that demand constant oversight through cueing, verbal prompting, or physical guidance.

"Substantial assistance" can mean hands-on help or standby assistance, depending on your specific policy language. Some Transamerica policies feature 0-day elimination periods for home health care, while others require 30, 60, or 90-day waiting periods before benefits begin.

The policy language sounds straightforward. The reality of getting Transamerica and LTCG to honor it? That's where the problems start.

Transamerica's Legal History and Allegations of Bad Faith

Transamerica's litigation history over the past decade reveals a pattern of corporate practices that prioritize profits over policyholder protection. While many of these cases focused on life insurance products, they demonstrate how the company responds when financial pressures mount—and they provide a roadmap for challenging Transamerica's denials in long-term care cases.

2018: $195 Million Settlement - Feller v. Transamerica Life Insurance Company

In what became one of the largest life insurance settlements of the decade, Transamerica paid $195 million to resolve a class action filed in 2016.

The allegations: Transamerica breached its contracts and acted in bad faith by raising monthly charges by up to 38% on universal life insurance policies sold in the late 1980s and early 1990s. These policies promised guaranteed minimum interest rates of at least 5.5% annually—attractive rates that reflected the high-interest environment of that era.

What happened: In 2015, Transamerica notified approximately 70,000 policyholders that it was dramatically increasing the monthly charges on their decades-old policies. Many of these policyholders were entering retirement, living on fixed incomes, and suddenly faced an impossible choice: pay premiums that had jumped by as much as 38%, or surrender policies they'd maintained for 25+ years.

The plaintiff's argument: Transamerica raised charges as a pretext to avoid or offset its obligation to pay the guaranteed monthly interest. The company wanted policyholders to relinquish their insurance so Transamerica could recoup losses it sustained from the low-interest-rate environment of the 2010s.

The settlement: Finalized in February 2019, the settlement provided $195 million to a common fund. Policyholders received either credits to their policy account values or cash payments if their policies were no longer in force. The settlement also included a five-year protection against additional rate increases.

Who represented the policyholders: Consumer Watchdog, along with Bonnett Fairbourn Friedman & Balint and Shernoff Bidart Echeverria & Bentley—firms with extensive insurance litigation histories. Harvey Rosenfield, the attorney with Consumer Watchdog, stated: "It took two years of hard-fought litigation, but we have accomplished our goal."

Why this matters for LTC policyholders: The same financial pressures that drove Transamerica to raise life insurance charges by 38%—low interest rates, underfunded reserves, corporate profit targets—apply to long-term care policies. The company's documented willingness to breach contracts and act in bad faith when money is at stake isn't limited to one product line.

2020: $88 Million Settlement - Thompson v. Transamerica Life Insurance Company

Just two years after the $195 million settlement, Transamerica faced another class action over similar practices.

The allegations: Between 2017 and 2018, Transamerica improperly increased monthly deduction rates on approximately 8,000 universal life policies in the TransUltra 115 98/99 and TransSurvivor 115 97/98/99 groups. Policyholders argued the increases exceeded what policy terms permitted.

Transamerica's defense: The company claimed the rate adjustments were "necessitated by low long-term interest rates, changes in expectations as to future mortality experience, and other factors, and in accordance with the policies' contractual terms."

The settlement: Approximately $88 million contributed to settlement funds benefiting policyholders with in-force policies, death benefit policies, and terminated policies. Final approval came in September 2020, though appeals delayed payments into 2021.

The pattern: This was the second major settlement within two years for rate manipulation tactics—a pattern that suggests systemic corporate behavior, not isolated incidents.

2017: $5.6 Million Jury Verdict - DCD Partners v. Transamerica

This case stands out because a jury actually ruled against Transamerica at trial, and the court issued an injunction—rare outcomes in insurance litigation.

The case: DCD Partners LLC, working with Rev. Cecil "Chip" Murray of First AME Church in Los Angeles, had established a life insurance program for the church's predominantly African-American congregation. Rev. Murray specifically sought an insurer that wouldn't engage in "redlining"—the practice of charging policyholders in the same policy class higher rates based on characteristics of their community or ethnic background.

What happened: Transamerica imposed unprecedented rate increases on these policies, just as it had with thousands of other universal life policyholders.

The verdict: On September 13, 2017, a federal jury rendered a verdict for DCD Partners on claims of breach of contract and breach of the implied covenant of good faith and fair dealing. Judge Christina A. Snyder of the U.S. District Court for the Central District of California entered final judgment on December 13, 2018, awarding $5.6 million.

The injunction: The court also enjoined Transamerica from continuing to charge excessive rates based on the increase the jury determined breached the insurance policy. This was the first injunction entered against Transamerica in any rate increase litigation since the company began raising life insurance rates in the late 2000s.

Media coverage: The Wall Street Journal reported on the case in an article titled "Federal Jury Rules Against Transamerica in Battle Over Rates," noting it was a "closely watched case that challenged the leeway life insurers have when raising rates on old policies."

Significance: A jury of regular people, hearing the evidence, concluded Transamerica violated its contracts and acted in bad faith. The judge agreed strongly enough to issue an injunction. This wasn't a settlement where the company could deny wrongdoing—this was a loss at trial.

2018: SEC Action - $97.6 Million

In August 2018—the same year Transamerica was finalizing the $195 million life insurance settlement—four Transamerica entities were ordered by the Securities and Exchange Commission to pay $97.6 million for misconduct related to faulty investment models.

Why this matters: This wasn't a private lawsuit. This was a federal regulatory agency finding that Transamerica entities engaged in misconduct serious enough to warrant nearly $100 million in penalties. It demonstrates corporate practices that extend across multiple business lines and that have attracted regulatory scrutiny at the highest levels.

2022: Same-Sex Couple Denial - Transamerica and LTCG Named

In 2022, a lawsuit was filed specifically naming both Transamerica and LTCG as defendants, alleging they denied long-term care benefits to an elderly woman by misclassifying her same-sex partner as an ineligible caregiver.

The allegations: The lawsuit claimed negligence on the part of LTCG in evaluating the claim and discriminatory denial practices by Transamerica.

The outcome: The denial was reversed on the same day the lawsuit was filed.

What this reveals: If the denial was so clearly wrong that it was reversed the same day legal action was taken, why was it issued in the first place? This suggests either incompetence in claims evaluation or a strategy of denying claims that appear vulnerable, hoping claimants won't fight back. Either way, it's a problem.

What This Pattern Reveals

Nearly $300 million in settlements and judgments over less than a decade. Multiple class actions. Jury verdicts. SEC penalties. Court injunctions.

This isn't a company with an occasional dispute. This is a pattern of corporate behavior that includes:

• Improperly increasing charges and rates to offset guaranteed obligations
• Bad faith claims handling prioritizing cost containment over contract terms
• Systematic denial practices affecting thousands of policyholders
• Practices serious enough to attract federal regulatory sanctions

The good news: These settlements and verdicts prove Transamerica can be held accountable. Policyholders who stood up, hired lawyers, and fought back won. Your LTC claim denial can be challenged too.

Tactics Transamerica (Through LTCG) Uses to Deny Claims

Since Transamerica transferred claims administration to LTCG in 2019, policyholders face dual corporate interests aligned against their benefits: Transamerica's financial motivations to limit payouts and LTCG's operational efficiency metrics. Based on complaints filed with state insurance departments, court documents in contested claims, and our experience representing policyholders, here are the practices that make securing benefits challenging.

Policyholders report excessive documentation requests. LTCG may send multiple requests for forms already submitted, demand granular details about every aspect of care, and request daily logs that are later challenged as "inconsistent." According to complaints filed with state insurance departments and accounts from policyholders we've represented, some claimants receive 15+ document requests over six months for the same claim. Each request comes with its own deadline and requirements, creating multiple opportunities for the administrator to find technical deficiencies.

LTCG frequently disputes treating physician assessments. In many cases, after a treating physician documents that a patient cannot bathe safely without assistance, LTCG sends their own nurse assessor for a brief evaluation—potentially even someone who doesn't specialize in the specific condition. Based on this single assessment, which may occur on a patient's "good" day, LTCG may conclude that the patient demonstrates abilities that contradict the treating physician's long-term observations. Policyholders report feeling pressured to demonstrate maximum capability during these assessments, only to experience exhaustion and setbacks afterward.

LTCG interprets ADL definitions narrowly. The policy language often includes terms like "substantial assistance," but LTCG's interpretation may differ significantly from what policyholders and their physicians expect. For example, LTCG has argued in various claims that standby assistance doesn't qualify as "substantial assistance," that care provided by family members doesn't count unless they're licensed aides, or that needing help with only certain aspects of an ADL (such as getting in and out of the tub but not washing yourself once you're in) doesn't meet policy definitions. These narrow interpretations can exclude legitimate care needs.

Insurers sometimes use surveillance in contested claims. In the 2024 case Transamerica Life Insurance Company v. Arutyunyan, Transamerica hired investigators to conduct surveillance on a policyholder claiming long-term care benefits, videotaping him walking his dog, reaching and bending, lifting objects with both hands, driving a car, shopping for groceries, and walking without a limp or assistive device—activities Transamerica used to argue against his claimed functional limitations. While insurers have the right to investigate potentially fraudulent claims, surveillance can capture isolated "good" moments—perhaps the day you pushed yourself to attend your granddaughter's birthday party—that don't reflect the daily reality of living with functional impairments.

LTCG rigorously enforces provider qualification requirements. Claims may be denied when a home health aide lacks a specific certification LTCG deems necessary, even if that aide has years of experience providing quality care. Similarly, assisted living facilities licensed by state authorities and meeting California or Arizona standards may still be rejected if they're not on LTCG's approved provider list. The challenge for policyholders: these specific requirements aren't always clearly disclosed in advance, leading to denied claims after care has already been arranged and costs incurred.

Elimination periods can be extended through restrictive day-counting. Policies typically require 90 days of qualifying care before benefits begin. However, LTCG may determine that certain days "don't count"—days when family provided care instead of licensed professionals, days when documentation doesn't meet their standards (even if those standards weren't clearly specified in advance), or days when the policyholder seemed "too functional" during a phone check-in. In our practice, we've seen elimination periods extend from 90 days to 150+ days through these interpretations, forcing policyholders and families to deplete savings during what should have been a finite waiting period.

File review by non-examining physicians is standard practice. LTCG, like many claims administrators, employs internal medical professionals or contracts with third-party physicians to review medical records. These reviewers don't examine claimants, may not specialize in the specific condition at issue, and base their opinions solely on documentation. When their conclusions contradict treating physicians who have monitored patients over months or years, claimants face the challenge of proving why their doctor's assessment—based on ongoing care and direct observation—should prevail over a paper review. The file reviewer doesn't see you struggle to dress yourself or forget whether you've eaten; they see a note in your chart from six months ago that says you "ambulated to the exam room without assistance" and may base denial decisions on that single observation.

Communication delays are common complaints. Due to the volume of claims LTCG processes for multiple insurers, policyholders frequently report that phone calls aren't returned promptly, emails go days without response, and status updates are vague or nonexistent. This leaves claimants uncertain about whether claims are being actively processed or facing issues, creating stress and financial strain—especially during elimination periods when out-of-pocket care costs are mounting.

Common Reasons for Transamerica/LTCG Claim Denials

The tactics described above might manifest as specific denial reasons in the letter you receive from LTCG or similar insurers. Here's how to translate what an insurer is actually saying:

"Insufficient documentation of functional limitations"

Translation: We're disputing your doctor's assessment and demanding documentation that may not exist or that we've defined so narrowly you can't provide it. We want daily care logs that account for every minute, physician statements that address every conceivable question we might raise, and functional assessments that meet criteria we haven't fully disclosed. When you provide what we ask for, we'll find it insufficient and ask for more.

"You don't meet the ADL requirements"

Translation: We're interpreting "substantial assistance" to exclude the help you actually receive. We're claiming that because you can technically perform certain aspects of an ADL without help (even if it's dangerous, exhausting, or takes 45 minutes), you don't qualify. Or we're arguing that standby assistance doesn't count. Or we're splitting hairs between "cueing" and "hands-on assistance" in ways that would make the policy's drafters shake their heads.

"Cognitive impairment not severe enough"

Translation: Our file reviewer—who's never met you, who reviewed your case for maybe 30 minutes—disagrees with your neurologist's assessment that you require substantial supervision to protect yourself from threats to your health and safety. They don't think your Alzheimer's or dementia is "bad enough" yet, even though you've wandered away from home twice, left the stove on, or failed to recognize your own family members.

"Care provider doesn't meet policy requirements"

Translation: We're enforcing licensing, certification, or facility requirements that may not have been clearly disclosed when you purchased the policy 20 years ago. Your home health agency is licensed by the state? Doesn't matter if they're not on our approved list. Your assisted living facility is fully qualified under California standards? We want additional accreditation that wasn't mentioned in the policy language. Your spouse providing care? They're not a licensed professional, so those days don't count.

"Policy lapsed due to non-payment"

Translation: You missed a premium payment—possibly after we raised your premiums dramatically, like we did to 70,000 policyholders in that $195 million class action—and we're using that technical lapse to escape our obligations. This is especially problematic for policyholders with cognitive decline who struggle to manage finances and may have missed payments because they forgot, didn't understand the bill, or couldn't comprehend the consequences. We're also claiming we followed proper notification procedures, though our records on that may be conveniently incomplete.

"Elimination period not satisfied"

Translation: We've decided certain days don't count toward your 90-day waiting period using technicalities about provider qualifications, service documentation, or our interpretation of what constitutes "qualified long-term care services." Your 90-day elimination period might actually take 120, 150, or 180+ days to complete using our creative accounting.

"Pre-existing condition exclusion applies"

Translation: We're claiming the condition requiring care existed before your policy started, even if that's disputed, even if you didn't know you had the condition, even if the policy language about pre-existing conditions is ambiguous. We're looking at medical records from years before your policy inception to find anything that could potentially be connected to your current need for care.

Each of these denial reasons can potentially be challenged with proper evidence, legal arguments, and aggressive advocacy. But you need to understand what you're actually fighting.

Transamerica's Rate Increase History and Policy Lapses

The $195 million settlement wasn't just about money—it was about broken trust. Policyholders who bought policies in the 1980s and early 1990s with guaranteed interest rates and reasonable premiums suddenly faced increases of up to 38%. Some were forced into an impossible choice: pay dramatically higher premiums that strained or broke their fixed-income budgets, or let policies lapse after decades of faithful payments.

Think about that. You paid premiums for 25 years. You're now in your 70s or 80s, exactly when you might need the benefits. And Transamerica—claiming financial necessity due to low interest rates—raises your premiums so high that you can't afford to keep the policy. You've paid in thousands of dollars over decades, and you walk away with nothing.

For LTC Policyholders, This History Matters

If your long-term care policy lapsed due to premium increases, don't assume you've lost all rights. Transamerica's documented pattern of excessive rate hikes—proven in court—may provide grounds to challenge the lapse, especially if:

• You weren't given proper notice of the rate increase or the lapse consequences
• The rate increase was part of the pattern addressed in the class action litigation
• You have cognitive impairment that affected your ability to understand the notices, manage policy payments, or respond to billing issues
• Secondary contacts weren't notified as required by the policy or state law when you missed payments

California and Arizona both have strict requirements for how insurers must notify policyholders before canceling coverage for non-payment. The notification requirements are even more stringent when the policyholder is elderly or has documented cognitive issues. If Transamerica and LTCG didn't follow every procedural requirement—and we investigate this thoroughly in every case—the lapse may be invalid.

We've seen cases where insurers claim they sent lapse notices but have no proof of delivery. Where they sent notices to the wrong address. Where they failed to contact the designated family member or representative when the policyholder stopped responding. Where rate increase notifications buried crucial information in fine print or used confusing language designed to obscure the full impact.

Don't let a policy lapse that occurred during a period of rate increases automatically end your fight for benefits. That lapse may itself be evidence of bad faith.

Why LTCG Administration Adds Complexity

Since 2019, Transamerica policyholders don't just deal with Transamerica—they're navigating LTCG's systematic approach to claims administration. And LTCG brings its own troubling history to the relationship.

What LTCG Brings to the Table

A documented pattern of "death by paperwork." LTCG, as one of the largest third-party administrators of LTC policies in the country, handles enormous claim volume. That volume-driven business model creates incentives for denial: the fewer claims paid, the better the metrics. The longer claims are delayed, the more policyholders give up or die before receiving benefits. The more documentation requested, the more opportunities to find technicalities for denial.

The CalPERS scandal. LTCG served as the third-party administrator for the California Public Employees' Retirement System (CalPERS) Long-Term Care Program when CalPERS raised premiums by 85% in 2012 despite prior promises of rate stability. The class action lawsuit (Wedding v. CalPERS) resulted in a settlement allowing policyholders to choose between refunds of 80% of premiums paid or continued coverage with adjusted terms. LTCG's role in administering a program that so dramatically betrayed policyholder trust raises questions about whose interests the administrator prioritizes.

The same-sex couple denial. In the 2022 lawsuit against Transamerica and LTCG, LTCG was specifically named for negligence in evaluating the claim that denied benefits by misclassifying a same-sex partner as an ineligible caregiver. The fact that the denial was reversed the same day the lawsuit was filed suggests the denial never had merit in the first place—it was either incompetent evaluation or a strategic denial hoping the policyholder wouldn't fight back.

Rigorous enforcement of provider requirements. LTCG scrutinizes caregiver qualifications and facility approvals with aggressive thoroughness. They enforce technical requirements that may not have been clearly disclosed in the original policy. They maintain "approved provider" lists that aren't always accessible to policyholders. They reject claims because a licensed, qualified caregiver lacks one specific credential LTCG has decided is required.

Communication black holes. With LTCG processing claims for multiple major insurers—including not just Transamerica but also CNA Insurance and the CalPERS program—individual policyholders can feel like case numbers lost in a bureaucratic maze. Phone calls to check claim status take hours. Emails go days or weeks without response. The person you spoke to last month is no longer handling your case. Your claim file sits in pending status while LTCG processes other claims, and the only way to get movement is to escalate, complain, or threaten legal action.

The Dual-Entity Problem

When you appeal a Transamerica claim denial, you're challenging both:

1. Transamerica's policy interpretations and financial motivations. The company has demonstrated through its litigation history that when financial pressures mount, contractual obligations get reinterpreted in ways that favor the bottom line. They've paid nearly $300 million in settlements for these practices, but that apparently hasn't changed the corporate culture.
   
2. LTCG's administrative decisions and procedural requirements. The third-party administrator has its own documented history of aggressive claims handling, its own business model that rewards denials and delays, and its own interpretation of what policy language means and what documentation is sufficient.
   

This dual-entity structure adds layers of complexity to appeals and litigation. You need legal representation that understands both Transamerica's history and tactics AND LTCG's specific processes and documented patterns.

For the complete picture of LTCG's role, their controversial CalPERS connection, their specific denial tactics, and the legal strategies that work against them, see our comprehensive LTCG page.

The bottom line: Transamerica transferred claims administration to LTCG in 2019, but they didn't transfer their responsibility to honor your policy. Both entities can and should be held accountable when they fail to meet their obligations.

What Rights Do Policyholders Have?

The good news: you're not powerless. Every state provides legal protections against insurance company bad faith and unfair claims practices, though the specific statutes and remedies vary. State insurance codes typically prohibit insurers from misrepresenting policy terms, failing to investigate claims properly, denying coverage without reasonable basis, and delaying payments unreasonably. When insurers violate these duties, policyholders have legal recourse through state insurance departments, administrative appeals, and civil lawsuits.

The strength of these protections—and the remedies available when insurers act in bad faith—depends on where you live and where your policy was issued. Some states allow punitive damages to punish egregious insurer conduct, while others limit recovery to the benefits owed plus interest and attorney fees. Understanding your state's specific protections is the first step in challenging an unfair denial.

Legal Protections Under State Law

California policyholders have strong protections under California Insurance Code §790.03, which defines unfair claims settlement practices:

• Misrepresenting pertinent facts or insurance policy provisions relating to coverages
• Failing to acknowledge and act reasonably promptly upon communications with respect to claims
• Failing to adopt and implement reasonable standards for the prompt investigation of claims
• Refusing to pay claims without conducting a reasonable investigation
• Not attempting in good faith to effectuate prompt, fair, and equitable settlements of claims in which liability has become reasonably clear
• Compelling insureds to institute litigation to recover amounts due under an insurance policy by offering substantially less than amounts ultimately recovered

California law also allows for punitive damages in bad faith cases—damages designed to punish the insurer and deter future misconduct. When an insurer like Transamerica, with nearly $300 million in recent settlements, continues to engage in questionable practices, punitive damages send a clear message.

Arizona policyholders are protected under A.R.S. § 20-461 (Unfair Claim Settlement Practices), which prohibits similar conduct. Arizona also recognizes common-law bad faith claims against insurers who unreasonably deny, delay, or underpay legitimate claims. While Arizona doesn't allow punitive damages in all bad faith cases, the remedies available—including attorney fees and interest on delayed benefits—provide meaningful relief.

Both states require insurers to:

• Investigate claims thoroughly and in good faith
• Pay legitimate claims promptly (typically within 30-60 days of receiving proof of loss)
• Communicate clearly about claim status and requirements
• Follow specific procedures before denying coverage

Both states also have strict requirements for lapse notifications—when and how policyholders must be notified before coverage terminates for non-payment, with additional protections for elderly and cognitively impaired policyholders.

Legal Protections Under Federal Law

If your Transamerica LTC policy is employer-sponsored (part of a group benefits plan), it's likely governed by ERISA—the Employee Retirement Income Security Act. ERISA provides:

• Right to full plan disclosure: You're entitled to receive a copy of your full policy (called the Summary Plan Description and the full plan document)
• Specific appeal procedures: ERISA requires insurers to provide internal appeal processes with strict timelines
• Right to sue in federal court: If internal appeals fail, you can sue in federal court
• Fiduciary duties: Plan administrators (including LTCG when handling employer-sponsored policies) owe fiduciary duties—they're required to act in the best interests of beneficiaries, not just maximize corporate profits

ERISA cases have different rules than state law claims—for instance, punitive damages generally aren't available, and there are strict deadlines for filing lawsuits after exhausting internal appeals. But ERISA also provides advantages: federal court jurisdiction, uniform standards, and a body of case law holding insurers accountable for unreasonable denials.

Your Right to Appeal

Every Transamerica/LTCG denial letter must include information about your appeal rights. But here's what they don't emphasize:

Deadlines are strict. Most policies allow 60-180 days to file an appeal, depending on whether the policy is governed by state law or ERISA. Missing these deadlines can permanently harm your case—courts generally won't let you revive an appeal that wasn't timely filed.

Appeals must be comprehensive. You can't just write a letter saying "I disagree." Your appeal must address every reason cited in the denial letter, provide new or additional evidence supporting your claim, and present legal arguments for why the denial violated policy terms or applicable law.

New evidence can be added. Unlike some legal proceedings where you're stuck with the evidence that existed at the time of the initial decision, LTC insurance appeals generally allow you to submit updated medical records, new physician statements, additional functional assessments, and other evidence that strengthens your case.

State insurance departments can help. California and Arizona both have insurance departments that investigate consumer complaints. Filing a complaint with the state regulator (California Department of Insurance or Arizona Department of Insurance and Financial Institutions) can trigger an investigation into Transamerica and LTCG's practices. While the department can't force approval of your specific claim, regulatory scrutiny creates additional pressure on the insurer to act reasonably.

Your Right to Sue

If internal appeals fail—if Transamerica and LTCG continue to deny your claim even after you've submitted compelling evidence and addressed their stated concerns—you have the right to file a lawsuit.

State law claims (for non-ERISA policies) can include:

• Breach of contract: Transamerica violated the terms of the insurance policy
• Bad faith: Transamerica unreasonably denied your claim, placing its own financial interests above its contractual obligations
• Remedies: Benefits owed, interest on delayed payments, attorney fees, emotional distress damages, and potentially punitive damages (especially in California)

ERISA claims (for employer-sponsored policies) typically focus on:

• Arbitrary and capricious denial: The administrator's decision had no reasonable basis
• Abuse of discretion: The administrator acted unreasonably given the evidence
• Remedies: Benefits owed, attorney fees if you prevail

Transamerica's nearly $300 million in settlements over the past decade—including jury verdicts and court injunctions—proves that these lawsuits can succeed. The company has been held accountable before. It can be held accountable for your denied LTC claim too.

How Can an Attorney Help With Your Transamerica Denial?

Transamerica has a legal department. LTCG has a legal department. They have decades of experience denying claims, defending lawsuits, and negotiating settlements. You need someone on your side who understands their playbook.

We Know Their History

Sandstone Law Group has studied Transamerica's litigation patterns—the $195 million settlement, the $88 million settlement, the DCD Partners jury verdict, the SEC penalties, the same-sex couple denial. We've analyzed LTCG's role as third-party administrator and their documented tactics in the CalPERS case and other complaints.

We know what to look for:

• The paperwork avalanche designed to overwhelm and create technicalities for denial
• The functional capacity assessments that contradict treating physicians without valid medical basis
• The provider qualification technicalities used to deny legitimate care arrangements
• The surveillance tactics meant to intimidate and cherry-pick "good" moments
• The elimination period manipulations that extend 90-day waiting periods to 150+ days
• The lapse claims that may violate notification requirements

We've seen these tactics before. We know how to counter them.

Our Approach to Fighting Your Denial

Comprehensive policy review. We read your entire policy—the base policy, all riders, all amendments, all rate change notices—to identify exactly what Transamerica owes you versus what LTCG is claiming. We look for ambiguous language that should be interpreted in your favor (the standard legal rule when policy terms are unclear). We identify any discrepancies between what was represented when you bought the policy and what's being enforced now.

Strategic evidence gathering. We work with your medical providers to document functional limitations in the language insurers must recognize under the policy terms and applicable law. We counter LTCG's file reviewers with independent medical evaluations from specialists who actually examine you and understand your condition. We build daily care logs that withstand scrutiny—detailed, consistent, and aligned with policy requirements. We gather witness statements from family members and caregivers who see your daily struggles.

Aggressive advocacy. We don't accept vague denial letters or bureaucratic runarounds. We demand that Transamerica and LTCG cite specific policy language supporting their denials. We challenge biased file reviews with evidence of reviewer conflicts of interest or insufficient expertise. We expose procedural violations—missed notification deadlines, inadequate investigations, failure to consider relevant evidence. We hold both Transamerica and LTCG accountable for every decision they've made.

Appeals or litigation—whatever your case requires. Sometimes a well-crafted appeal with proper medical evidence and strong legal arguments resolves the denial. LTCG reverses course when faced with evidence they can't reasonably dispute. Other times, litigation is necessary—either because the denial is so unreasonable that only the threat of trial will change it, or because the insurer needs to be held accountable through a jury verdict or settlement. We assess your case individually and recommend the strategy most likely to succeed.

Bad faith claims when warranted. If Transamerica and LTCG's denial is unreasonable—if they're clearly prioritizing cost savings over contractual obligations, if they're enforcing policy terms that contradict what was represented to you, if they're ignoring compelling medical evidence—we pursue bad faith claims. In California especially, bad faith claims can include punitive damages designed to punish the insurer's conduct and attorney fees that make the litigation economically viable even when benefit amounts are modest.

Why Legal Help Matters

Transamerica has paid out hundreds of millions in settlements because policyholders stood up, hired lawyers, and fought back. The DCD Partners jury verdict happened because someone refused to accept the denial. The $195 million class action succeeded because attorneys with insurance litigation expertise recognized the pattern and built an overwhelming case.

Your claim may not be a class action. But the same corporate tactics are at work. The same financial pressures that drove 38% rate increases on life policies affect LTC claims. The same LTCG administration that reversed the same-sex couple denial the day a lawsuit was filed is handling your claim.

Don't let their resources, their legal departments, or their documented history of fighting claims intimidate you. The law is on your side. Their own litigation history proves they can be beaten.

What Should You Do If Your Transamerica Claim Is Denied?

Speed matters. Evidence matters. Strategy matters.

Immediate Steps

1. Read the denial letter with a pen in hand. Note every reason LTCG cited for the denial. Circle every policy provision they referenced. Highlight every deadline mentioned. This letter is your roadmap for the appeal—you must address every point they raised, or they'll claim you didn't properly exhaust your appeal rights.

2. Gather your complete policy. You need your original policy document, all riders, all amendments, all rate change notices, and any correspondence you've received over the years. Insurers sometimes enforce provisions that weren't in your original policy, or interpret language in ways that contradict what was explained when you bought coverage. You need to know what Transamerica actually promised versus what LTCG is now claiming.

3. Collect all correspondence. Every letter from Transamerica or LTCG. Every email. Every document request. Every form you submitted. Create a timeline showing when you filed the claim, what they asked for, what you provided, and how long each step took. This timeline can reveal patterns—excessive delays, repeated requests for the same documents, unreasonable demands.

4. Request your complete claim file. You have the right under state and federal law to see everything Transamerica and LTCG have about your claim—the denial rationale, file reviewer notes, internal communications, the criteria they used to assess your ADLs or cognitive impairment. Request it immediately. You need to know what evidence they relied on and what they ignored.

5. Don't navigate this alone. Given Transamerica's litigation history, LTCG's documented tactics, and the complexity of fighting a dual-entity denial, legal expertise isn't optional—it's strategic. The company has lawyers. You need a lawyer too.

Building Your Case

Updated medical documentation. Your treating physicians need to address every functional limitation LTCG disputes. If LTCG claims you can bathe independently, your doctor needs to explain in detail what "bathing" actually involves for you—getting in/out of the tub, washing areas you can't reach, the fall risk, the exhaustion that follows. If LTCG disputes cognitive impairment severity, your neurologist needs to document specific examples of when you've gotten lost, forgotten critical information, or posed a danger to yourself.

Care logs that withstand scrutiny. Document every day of care with the provider's name, specific assistance provided (not just "bathing assistance" but "helped into shower, washed back and legs, stood by for safety while patient washed front, helped out of shower, helped dry off"), and time spent providing care. Anticipate LTCG's challenges and address them proactively. If your spouse provides some care, clearly distinguish which tasks require their assistance and which you can do alone.

Provider qualification verification. Ensure all caregivers and facilities have proper licensing that meets policy requirements. If LTCG's requirements are unclear—if the policy says "licensed caregiver" but doesn't specify which license—document that ambiguity. Get written confirmation from providers about their qualifications. If you're using a home health agency, get their license numbers and accreditation information.

Appeal deadline tracking. Mark your calendar with the appeal deadline. Set multiple reminders. Missing the deadline—even by one day—can permanently harm your case. Courts generally won't excuse late appeals even if you have a good reason. The deadline is typically 60-180 days from the denial date, but read your denial letter carefully because your specific policy might be different.

What Not to Do

Don't give up. That's what they're counting on. Transamerica and LTCG know that many policyholders, especially elderly or cognitively impaired individuals, will receive a denial letter, feel overwhelmed, and simply stop fighting. Don't let bureaucratic obstacles or corporate tactics discourage you from pursuing benefits you've earned.

Don't miss deadlines. This is critical. Appeal deadlines aren't flexible. If you miss the deadline for internal appeals, you may lose the right to sue. Courts generally won't excuse late filings unless there are extraordinary circumstances.

Don't accept the denial as final. The first denial is often just the beginning. Many denials are reversed on appeal when policyholders provide additional evidence or when lawyers challenge the legal basis for the denial. The $195 million settlement, the jury verdict, the reversed same-sex couple denial—all of these started with someone who refused to accept "no."

Contact Sandstone Law Group Today

Transamerica has paid nearly $300 million in settlements and judgments over the past decade for practices that prioritized corporate profits over policyholder protection—38% rate increases, bad faith denials, breach of contract. LTCG's administration adds another layer of bureaucratic obstacles between you and your benefits, with documented patterns of excessive documentation demands, aggressive provider qualification enforcement, and claims handling that favors denial.

But here's what the company's litigation history actually proves: they can be held accountable.

You paid premiums for years—maybe decades—trusting that Transamerica would be there when you needed long-term care. The company transferred claims administration to LTCG in 2019, but they didn't transfer their obligations under your policy. Both entities can and should be held to their commitments.

The $195 million settlement came because 70,000 policyholders stood together and fought back. The DCD Partners verdict came because a church community refused to accept discriminatory rate increases. The same-sex couple's denial was reversed because someone filed a lawsuit the same day. These victories didn't happen by accident—they happened because people challenged corporate practices that violated their contractual rights.

We know how to counter the paperwork avalanche. We know how to challenge biased file reviewers. We know how to prove functional limitations that meet policy definitions. We know how to expose procedural violations. We know how to build bad faith cases when denials are unreasonable.

Don't let their history of litigation intimidate you—let it empower you. They've been challenged before. They've paid out before. They've lost jury verdicts before. Your case could be next.

Call (602) 615-0050 or contact us online for a free consultation. We'll review your denial letter, explain what Transamerica and LTCG are actually claiming, assess the strength of your case, and outline the strategies available to fight for your benefits. You paid for long-term care coverage. You deserve to receive it.

The premiums are paid. The condition is documented. The care is needed. Now it's time to hold Transamerica accountable for the promises they made.