Long Term Care Claims Denied?

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The case of a Pebble Beach California resident against the Chicago based CNA Financial group is now going to federal court. A lawsuit filed in February claims that a 91 year old required home care and that the long term care insurance company that she had paid premiums to for years actually denied her claims when she needed them the most. On Tuesday, a judge decided to move the case to the U.S. District Court in San Jose because it could involve over $75,000 and the financial group is located out of state.

Mediation with the CNA Financial group was attempted, but was unsuccessful. According to the suit, CNA Financial ignored the advice of three doctors when processing the claims for the woman’s medical bills. The group even ignored the advice of one of its own doctors. Although efforts to reach the group were unsuccessful, it has been said that a spokeswoman said that the company disagrees with the woman’s lawsuit and that they are willing to defend themselves in court to prove that they were justified in denying her claims. The woman who filed the lawsuit shares a different perspective - one that many who have invested in long term insurance care would willing echo.

The woman had paid for long term care insurance from CNA Financial group since 1996. After a hospital stay in 2011, her doctors had said that she should no longer live alone based on her health condition. One doctor provided evidence that the woman required supervision in her home because of conditions include cognitive impairment, hypertension, and hyponatremia. The woman’s family had hired caregivers to help supervise her and provide care, but the claims for them were denied by the CNA Financial group. As it stands, the claims have still not been reimbursed.

This is a case that has been gaining controversy throughout the country as evidence and information has continued to build. Many people invest in long term care insurance on a regular basis because they want to ensure that they will have some form of coverage that will be able to provide for them in their senior years if they become ill or find themselves in a condition where they need assistance with the basic activities of daily life. However, what most people fail to think about is what they would do if they ever found themselves in a situation where their claims for care were denied by their long term care insurance company. Although it’s not a common situation, this case is proof that it can occur and that seniors need to have a backup plan just in case some issue should arise where their claim is not able to be reimbursed or there are issues with the insurance provider. Under those circumstances, having an additional source of income or funding would be an ideal way to ensure that care can still be provided and paid for without the worries of whether or not a claim can be approved.

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