Articles Posted in LongTerm Care Insurance

Recently, the Commerce Department of Minnesota fined Bankers Life and Casualty Company $20,000, as a result of complaints about the long term care insurer’s failure to pay timely claims and pay interest.

“Consumers invest in long-term care insurance so that when the time comes, they will have coverage for care expenses. The department is here to make sure that consumers receive all the benefits that their insurance company should be covering,” Mike Rothman, the Minnesotan Commerce Commissioner, said in a statement.

Furthermore, according to a consent order issued on March 11, a Commerce Department approved independent reviewer must review more than 100 past long-term insurance claims to determine if they were handled adequately.

From time-to-time we review a health insurance policy for a client who has been denied medical treatment, services, or benefits and we find that their policy contains a binding arbitration provision. Oftentimes our clients are surprised to hear this and need help understanding what this means for them and their case.

Arbitration is an out-of-court proceeding in which a neutral third party, called an arbitrator, hears evidence and then makes a binding decision. Arbitration is the most commonly used method of Alternative Dispute Resolution. Indeed, if you look closely enough, you may find an arbitration clause in the fine print of all kinds of contracts these days.

As an alternative to judges or courts settling disputes between consumers and businesses, binding arbitration works out a deal through an independent, third-party – the arbitrator. Binding arbitration may save time, money, and energy when two parties disagree over a contract, the performance of a service, or the exchange of goods. The arbitrator’s decision is final and cannot be disputed or appealed.

While we certainly do not recommend it, you may choose to handle your own short term disability or long term disability claim.

If you decide to make a disability claim on your own, there are at least three things you should keep in mind when dealing with an insurance company.

1. Insurance Companies are For-Profit businesses.

Congratulations to Kantor & Kantor’s associate Brent Dorian Brehm for being selected to Super Lawyer’s 2014 Southern California “Rising Stars” list! This special recognition highlights Brehm’s exceptional work in ERISA/ bad faith insurance litigation as a young emerging legal leader.

Acknowledgment through this impressive list is attained through a systematic and multiphase selection process. Professional achievement is assessed annually (on a state-by-state basis) through peer nominations and evaluations, and carefully combined with third party research. This comprehensive and diverse list of outstanding attorneys is utilized as a resource for attorneys and consumers searching for reputable legal counsel. The final published list represents no more than 5 percent of the lawyers in the state.

Brehm, an 8th year associate, has spent his entire career advocating for individual’s rights to disability, life, health, and long term care insurance benefits with one of the preeminent firms in the area of ERISA (Employee Retirement Income Security Act) and bad faith insurance litigation, Kantor & Kantor, LLP. While with the firm, Brehm has resolved well over 150 disputes with insurance companies on behalf of his clients, and has made the transition to lead attorney on many of his cases. At least 13 nationally reported decisions in his client’s favor (including five cases published in the official reporter and five trial judgments in which Brehm was lead counsel) speak as testament to Brehm’s advocacy, skill, and experience gained through practice.

Insurance benefits provided by your employer benefit plan are usually governed by the federal laws of ERISA (Employee Retirement Income Security Act). Not all plans are insured, and instead may be self-funded. But, when they are insured, your dealings will almost always be exclusively with an insurance company.

Under ERISA, you are entitled to receive, upon request and free of charge,”reasonable access to, and copies of all documents, records, and other information relevant to your claim for benefits, including any guidelines relied upon in making this determination.”

The quote above is standard boilerplate language that appears at the end of almost every denial letter issued by a health, life, or disability insurance company when the benefits are governed by ERISA. In such a case, an insurer is required by federal law to give you access to almost all of the documents they utilized in making a claim determination. This includes, but is not limited to, the policy or plan, the medical records, internal notes and memos, and the notes of their reviewing physicians.

We often see claims denied or terminated based upon the report of a reviewing physician’s alleged conversation with a client’s treating physician. Problems frequently arise when a physician retained by the insurance company attempts to contact an insured’s attending physician to discuss an insured’s claim. Unfortunately, the insurer’s physicians do not make an appointment to speak to the insured’s physician and prefer to “cold call” the attending physician in the midst of a busy practice schedule. This creates several problems. First, the attending physician may not be able to take the call because he or she is treating patients. As a result, the insurer’s physician notes that the attending physician did not take his call and an implication is raised that the insured’s physician does not support the claim.

Second, even if your physician is able to take the call, he or she may not be prepared to thoroughly discuss the claim or the restrictions and limitations without a review of his or her records. If pressed for answers regarding the date of last examination or clinical findings, the attending physician may not be able to give complete or accurate answers.

Finally, we often find that the questions posed to the treating physician are misleading or incomplete. For example, the reviewing physician may ask the treating doctor if the insured is able to work or “do something.” This may not be the accurate criteria for disability under your policy. The ability to work part time or perform another occupation may not be the correct definition of disability under the Policy. The reviewing physician may then write a misleading report, indicating that the treating physician was “in agreement” that the insured could “return to work.”

Kantor & Kantor is honored to announce the selection of four attorneys from the firm for the 2014 Southern California Super Lawyers list. Inclusion in this list is reserved for attorneys who exhibit distinct excellence in their practice.

Super Lawyers, a prominent attorney rating service, identifies exceptional lawyers from more than 70 practice areas. The selected attorneys have attained substantial peer recognition and widespread professional achievement. The extensive and multiphase process used to determine 2014 California Super Lawyers relies on peer nominations, evaluations, and independent research.

All four lawyers were selected for their successes in representing people denied disability – particularly those with disabling conditions such as eating disorders, autoimmune diseases, Alzheimer’s, Parkinson’s, Multiple Sclerosis, cancer and mental illness – as well as assisting people recover benefits under long-term care, health and life insurance policies. This recognition and honor demonstrates the talent, dedication, and diligence of these attorneys; all of which they utilize to obtain the insurance benefits to which their clients are entitled.

Are you thinking about long-term care insurance, but not sure where to start? Not sure what it covers or who will pay for it? Do I qualify? Does my regular health insurance carry a rider which includes long term care? Well, stand by because I’m about to show you long term care is more than just about insurance, it’s a valuable service anyone can use.

Unlike regular health insurance policies which cover incurring medical expenses, a long-term care insurance policy is “designed to cover long-term services and supports including personal and custodial care in a variety of settings such as your home, a community organization, or other facility” (Longtermcare.gov).

A study done by Roger and Komisar found that almost 10 million people in the United States alone, needed some type of long-term care and 3.6 million were under the age of 65! Most studies assume at least 70% of people over 65 will need long-term care.

Things You Should Know About Attorney’s Contingency Fees

When you hear the word “attorney,” what is your first thought? You might be thinking,“attorneys are too expensive, I can’t afford to work with one!” or…”I can deal with these insurance issues on my own.”

At Kantor & Kantor, we understand that our clients are already under a great deal of emotional and financial pressure due to injury, illness, or a serious health issue. When this happens, financial resources are quickly assessed and allocated to health related expenses (doctor and specialist visits, prescriptions, procedures and treatments, alternative medicine) – not to something outside of the budget like an attorney. Furthermore, if you are suddenly unable to work, the burden of your illness can feel insurmountable…and working with an attorney can feel nearly impossible.

When we hear the phrase long term care, most of us intuitively think of care and assistance for the elderly. While the majority of long term care is provided for the aging population, long term care services can also become necessary for younger individuals. In fact, the U.S. Government Accountability Office estimates that 40% of the 13 million people receiving long-term care services are between ages 18 and 64. The need for long term care can arise suddenly from age-related declining health, cognitive disorders, disability, illness, or injury. Any age group, social or economic class, or ethnicity can be affected by an unexpected need for long term care.

The purpose of long term care is to provide assistance with everyday tasks (or Activities of Daily Living) when illness or injury prevents someone from taking care of their personal or health needs. For example, long term care can offer support and services for bathing, eating, dressing, using the toilet, managing finances and medications, and much more.

Many people wonder if purchasing a long term care insurance policy is the right choice. If you consider the cost of out of pocket long term care expenses, paying premiums on a policy can be well worth it. Failure to plan ahead for long term care can place the burden of financially overwhelming expenses onto loved ones. For instance, a semi-private room in a nursing home can cost about $205 per day, a one-bedroom room at an assisted living facility can cost about $3,293 per month, and a home health aide can cost $21 per hour.

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