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Frequently Asked Questions

Do you charge a fee for an initial consultation?

No. The initial consultation is free of charge. Call toll free to schedule your consultation at: (855) 693-9256

I cannot afford to pay hourly for your time, do you accept cases on a contingency basis so that I only have to pay an attorney fee if there is a recovery?

Yes, depending on the facts of the case we can accept on a contingency basis. In those cases, payment will be for an attorney fee if there is a recovery.

What is Long Term Care (LTC) Insurance?

Long term care insurance is a form of health insurance that is designed to assist an insured with the high costs of long term care from aides and nurses. Typically this type of insurance is purchased to provide a benefit when an elderly insured needs the assistance of home health aides in their own private home, or the expenses related to a stay at an assisted living facility/nursing home.

What is the difference between Accidental Death and Dismemberment (or AD&D) insurance and life insurance?

Life insurance pays a benefit to your designated beneficiary when you die, accidental death insurance pays a benefit to your beneficiaries only if you die an “accidental” death. Insurance companies typically deny AD&D claims by arguing that the death was not accidental.

Does long term care insurance cover assisted living facilities?

It depends on the language in your LTC insurance policy. Very often long term care insurance carriers incorrectly claim that their policies only cover skilled nursing facilities when the actual policy language is much broader, and should afford assisted living facility coverage as well.

Does long term care insurance cover home health aides?

It depends on the language in your LTC insurance policy. Sometimes carriers argue that only certain types of licensed home health care providers are covered by the policy, when in fact the language in the policy is much broader.

Should I appeal a claim denial on my own?

No, never file an appeal of an insurance company’s claim denial without first consulting a lawyer experienced in that particular area of law. Insurance companies hide the pitfalls of filing an appeal without representation and mistakes made during this process could hurt your ability to pursue the insurer for benefits if they uphold the denial. It is free to have an initial consult with most lawyers, certainly do at least that before trying to file an appeal on your own.

Why do I need a lawyer to help with appealing a claim denial?

For claims that are subject to the Employee Retirement Income Security Act (ERISA) an improperly filed appeal of a claim denial could forever impact your ability to pursue the insurance company in court through litigation. Insurance companies have their own teams of lawyers watching their every move, it is not wise to go it alone when faced with a well-staffed adversary.

If a life insurance policy lapses prior to death, does the insurance company have to pay the claim?

Insurance companies sometime try to claim a life insurance policy lapsed prior to death (often due to nonpayment of premium), when in fact the policy may still have been in force during a mandatory late premium grace period. Do not trust the insurance company telling you that a policy lapsed, consult with an experience life insurance lawyer for their opinion as to whether the policy truly lapsed.

Is a death due to a drug overdose covered by an accidental death insurance policy?

Sometimes yes, sometimes no – it depends on the language in the policy. Do not trust the insurance company’s interpretation of the policy language, consult an experience life insurance lawyer. We have experience fighting carriers for accidental death benefits when the cause of death is an accidental drug overdose.

Can a life insurance company exclude suicide as a cause of death?

It depends on the state where the policy was originally issued. Call a lawyer, do not trust what the insurance company tells you.

Who is covered by an accidental death insurance policy?

It varies depending on the policy language, however many people do not realize that all members of their immediate family can be covered by an accidental death policy provided by an employer. Therefore in the event of an accidental death of not just the employee but anyone in the employee’s immediate family, the insurance company is liable for a benefit to the survivor beneficiaries.

What are some reasons given by an AD&D insurance company as to why a claim is being denied?

AD&D insurers often claim that a person killed by a drug overdose or killed by a violent act of another did not die an accidental death under the terms of the insurance policy. Often times there is no actual support for the insurance company’s position, and we fight them on these issues.

 

Other times AD&D insurers claim that an insured’s pre-existing medical condition caused or contributed to the accident occurring, therefore the death was not truly accidental. This comes up when an accident occurs with no witnesses. The insurance company will scour medical records looking for evidence of a pre-existing condition that could have led to a car crash or a fatal trip and fall. We fight insurers over these issues, and their attempts to improperly cast an accident as a non-covered medical event.

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