A contract is a contract, and a long term care insurance company has the right and responsibility to follow it's policy's wording to the letter. Buyers BEWARE! Companies can "interpret" vague wording in their favor. So, it's a very good idea to enlist the expertise of an insurance coverage contract lawyer in the very beginning, rather than waiting until being denied. Just know that lawyers are pricey, so be prepared to spend some extra cash for this last step.
Unless you are well versed in contract law and know the in's and out's of the insurance industry's language, do not supposed that you are smarter than your long term care insurance company's lawyers. Make sure you know what you are buying.
Checking policy wording with a contract lawyer who knows the long term care insurance lingo while also making sure you have a competent and compassionate long term care insurance broker in your corner is the best of both worlds.
Brokers can be very helpful, as long as they are consumer-focused, however they are not trained in law. Even Clay's long term care insurance mentor/trainer, who had years of experience, was caught unaware a few times. After believing a policy's wording meant that it promised coverage under certain circumstances, Charlie was devastated and infuriated to learn that a client's claim was questioned. Charlie wasn't a lawyer, and in good faith he believed what the insurance company had alluded to during his training. Maybe he was too trusting. His training was about sales, not about specific wording in a particular policy and the legal ramifications of such wording for his clients.
However, IF a long term care insurance company tries to deny your claim, your broker can go to bat for you arguing in your behalf. Charlie did this for his clients and he won. Often a broker can push a claim through, when a consumer cannot. They can't argue law, but some do have "pull". This is especially true if the broker is an long term care insurance company's top producer. The company doesn't want to upset the broker and risk losing future sales, even if they are vaguely within their rights to deny a claim. (I say vaguely, because some policies are vague in their wording. )
So, if you do need assistance getting your claim approved, you might want to see if your broker can help before spending money on a lawyer. Please note: There may be time limitations pertaining to filing an appeal or contesting an insurance company's denial of claim/benefits. If you think your claim has been unjustly denied, do not delay. Act right away.
NOTE: Read your policy to see if you will need to file your claim within a certain amount of time. Some policies require written notice within 30 -90 days from the verification of disability.
Call your long term care insurance agent as soon as you need to receive benefits. A conscientious broker will assist you with your claim. Agents should consider it part of their job. Some agents may even go the extra mile by helping you fill out your paperwork and making sure it gets filed in time.
It's good to know that you have a trusted broker to lean on during what may be a confusing and heart-wrenching time.
