California Long-Term Care Insurance Lawyers

With Offices in Newport Beach, San Diego, San Francisco & Los Angeles

Long-term care insurance has been one of the fastest-growing types of insurance sold in recent years.  These policies are typically purchased privately outside of the employment setting and are governed by state laws, which usually provide a broader array of damages for policyholders than do policies governed by the Employee Retirement Income Security Act (ERISA).  If an insurer unreasonably and without proper cause denies a long-term care insurance claim by engaging in bad faith conduct, a policyholder may sue for benefits due under the policy, “consequential damages” (damages that are caused by the bad faith conduct), emotional distress damages, punitive damages, attorneys’ fees and interest on past-due benefits (typically at the legal rate of 10%).

Regardless of your specific coverage, insurers have a financial incentive to collect premiums and pay out less in benefits, which will increase their profits.  This conflict of interest can motivate insurance companies to improperly deny your long-term care insurance claim.  McKennon Law in California, is an experienced long-term care insurance attorney team of insurance litigation attorneys prepared to represent you.

Ready to Handle Your Long-Term Care Insurance Denial

Typically, long-term care policies contain technical language that specifies coverage for specific treatments and requirements.  Claimants must prove that they cannot perform a certain number of “Activities of Daily Living,” which typically means any of the following:

• Bathing: Washing oneself by sponge bath or in either a tub or a shower
• Dressing: Putting on and taking off all items of clothing and any required braces, fasteners or artificial limbs
• Transferring: Moving into or out of a bed, chair, or wheelchair
• Toileting: Getting to and from the toilet, getting on and off the toilet
• Continence: Ability to maintain control of bowel and bladder function
• Eating: Feeding oneself by getting food into the body from a receptacle or by a feeding tube or intravenously

These types of claims are similar to long-term disability insurance claims, and insurance companies will often follow similar practices in denying long-term care and disability insurance claims. These practices include taking medical evidence out of context, hiring biased doctors to evaluate claims, conducting an inadequate or biased investigation, and using surveillance and other methods to assert that an insured does not qualify for long-term care benefits.  Moreover, insurance companies delay paying claims, in part by requiring an unreasonable amount of documentation to establish entitlement to long-term care benefits.

Our Long-Term Care attorneys will not let insurance companies push you around.  Since 1986, we have negotiated and litigated cases involving long-term care insurance.  We are among the nation’s top law firms in working with long-term care insurance claims.  For more information, please see our Long-Term Care FAQs.

Understanding Bad Faith Practices by Insurance Companies

Insurance companies have a legal obligation to act in good faith when evaluating long-term care insurance claims. In California, state laws imply a covenant of good faith and fair dealing in every insurance contract. This mandate ensures that insurers do not prioritize their financial interests over the legitimate needs of policyholders. When an insurer fails to meet this obligation by unreasonably withholding policy benefits, it may be held liable for bad faith. Common bad faith practices include failing to conduct a prompt and thorough investigation or misinterpreting policy language to avoid payment.

A frequent tactic used by long-term care insurers involves the selective use of medical records. An insurer may ignore favorable evidence from your treating medical professionals and instead rely on the opinions of biased third-party reviewers who have never examined you. Furthermore, they may demand an unreasonable amount of documentation or repeatedly request additional information to cause delays. These delays often place individuals in a difficult time, as they may lack the financial security to pay for necessary personal care services while waiting for a claim decision.

If an insurance dispute arises from these actions, policyholders have the right to seek compensation beyond the original policy limits. In a successful insurance law case, a court may award punitive damages to punish the insurer for its misconduct. Our experienced attorneys have a proven track record of representing policyholders against major insurance companies. We understand the complex legal process required to hold these entities accountable and ensure you receive the benefits you were promised.

Challenges in Securing Long-Term Care Benefits

Obtaining long-term care benefits often requires navigating a complex web of requirements established by insurance policies. Most plans utilize “triggers” based on the ability to perform activities of daily living. While these criteria seem straightforward, insurance companies frequently challenge the severity of an individual’s impairment. They may hire investigators to conduct surveillance, attempting to find any evidence that contradicts the claim of a policyholder. Even minor activities captured on film can be taken out of context to justify a denial of coverage.

Another significant hurdle involves the transition from home care to a nursing facility or nursing home. Some older policies contain restrictive clauses that require a prior hospital stay or confinement in a specific type of facility before benefits begin. While many California state laws have limited the enforceability of these provisions, insurers may still attempt to use them to discourage claimants. Additionally, cognitive impairments such as Alzheimer’s or dementia present unique challenges, as insurers often apply subjective standards to determine if the level of supervision required meets the definition of care insurance coverage.

Our firm is highly recommended for our ability to gather medical records and objective evidence to counter these insurance company tactics. We work closely with medical professionals to document the necessity of assistance with daily living and personal care services. By providing comprehensive legal representation, we help our clients overcome these obstacles and obtain the financial support they need for their long-term health. We are committed to protecting your best interests and ensuring that the insurer honors its commitment to your care.

Navigating the Appeals and Litigation Process

When a claim is denied, the legal process for recovery typically begins with a formal appeal. It is vital to review the denial letter carefully, as it serves as a roadmap for the specific evidence needed to overturn the decision. During this stage, our law firms focus on building a robust record by coordinating with doctors to obtain detailed medical records and statements that address the insurer’s specific concerns. A well-prepared appeal is often the most effective way to secure a settlement without the need for a prolonged lawsuit.

If the internal appeal process does not result in a favorable outcome, litigation may be necessary to protect your financial security. Our insurance lawyers are prepared to represent you in courts throughout California, including San Francisco, San Diego, and San Jose. We handle these cases on a contingency fee basis, meaning our fee structure is designed so that you do not pay attorneys’ fees unless we successfully recover benefits for you. This approach allows families to pursue justice against powerful long-term care insurers without the burden of upfront costs.

Throughout our history, we have maintained a strong reputation within the legal community for our dedication to insurance law. We understand that dealing with a denied claim is a stressful experience for you and your loved one. Our firm provides the guidance and advocacy necessary to navigate these disputes and hold insurance companies to their promises. Contact our office today for additional information on how we can assist you in securing the policy benefits you deserve.

Schedule a Meeting Now With Our California Long-Term Care Lawyers Today!

If you or a loved one has been denied a long-term care insurance claim, you can rely on the skills and experience of McKennon Law in California.  For more than three decades, we have guided clients from throughout California, including the Orange County / Los Angeles area and Northern California.  We offer free initial consultations, so please contact us via this free consultation form or by calling 1-800-682-4137.