Nursing Insurance Claims - How can you get what you deserve?

Instead of offering proper coverage in situations where a person needs close nursing care, long-term care insurance policies are often revealed as a worthless 'piece of paper' that does not fulfill its purpose.

(Illustration: ShutterStock)

Adult man in wheelchair with nursing nurse (Photo: ShutterStock)

As is customary in nursing policies, a person will be recognized as a nurse in need of close support if his or her health and functional condition meets one of the following definitions:

1. The person is mentally depleted - a condition in which the patient's cognitive abilities have receded to the point of impairing their daily functioning, for example due to Alzheimer's disease or dementia.
2. Man is unable to perform at least half of the ADL test on his own, which includes six counts: walking, controlling the braces, eating and drinking, dressing and undressing, bathing, standing, and lying down.

A person who is defined as having a long-term care need is entitled to a social security benefit, but the allowance is significantly lower than the amounts required to finance the close and regular care the nursing person needs, which may cost thousands of shekels a month.

Recognizing that many older people come into nursing status, and with a desire to ensure proper care, without burdening the family, many seek to purchase long-term care insurance policies through health funds or workplaces (collective policies), or privately. However, when needed, after years of payments to the insurance company, many nursing patients are forced to find that they do not receive the coverage they thought was guaranteed.

Who (not) came to dine

In long-term care insurance, more than a third of the claims filed are rejected by insurance companies. The insurance companies' prominent claims for dismissal of claims are varied: the patient does not meet the criteria of nursing status, there is a statute of limitations on the claim, the patient did not disclose information about his previous medical condition and the like.

Applying for legal advice may turn the bowl around and help a person in long-term care to receive the benefits he or she is entitled to even if the insurance companies refuse payment.

It is important to note that regarding the statute of limitations, for example, only filing a lawsuit with the court will stop the statute of limitations, whereas when the claim is filed with the insurance company, the statute of limitations continues to accrue. A lawyer's appeal for a statute of limitations freeze until a claim is filed and / or during negotiations with the insurance company, may allow policyholders to prevent the insurance company from raising the statute of limitations.

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Many policyholders hold more than one long-term care policy (illustration: ShutterStock)

Story checked insurance policy (Photo: Walla system! NEWS)

Multiple Deals? Definitely yes!

Many policyholders hold more than one long-term care policy, whether it is through health insurance, private insured purchase or work-related insurance.

It is important to know that in the field of long-term insurance there are multiple offers, and the insured can receive payment from two different policies, provided that the payment in both policies is not defined as compensation but as compensation.

When the payment is set as indemnity, the insured will receive payment from the insurance company for expenses paid by him. The total payment in this case depends on the actual insured's expenses, so there may not be a parallel payment from another policy defined as indemnity. A payment that is defined as compensation, however, is given regardless of the insured's expenses, and can be received independently of the existence of an additional policy.

In the event of such a claim, it is advisable to contact a specialist in the field of long-term care insurance to ascertain all the necessary nuances and ensure that all your rights are exercised.

Attorney Meital Bachar and Ramoth and Attorney and Notary David Yedid from the Law Firm and Notary David Yedid. The firm deals with tort and insurance, the exercise of rights for third parties, the issuance of Portuguese citizenship and European citizenship in general.

Phone: 053-9374940

The article is courtesy of Zap Legal

The information presented in the article does not constitute or replace legal advice and does not constitute a recommendation for taking proceedings or avoiding proceedings. Anyone who relies on the information contained in the article does so at his own risk.