How do you file a complaint against a long term care insurance company?

Filing a complaint against a long term care insurance company is a three step process. You will need to contact the provider, start an appeal and, if your needs are not met, contact your state’s department of insurance.

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Long term insurance companies are like any other business. There are times when they do not meet their customers’ expectations and disputes arise. Policyholders should have their concerns dealt with promptly and in a professional manner. When the individual has tried to deal with the company and is still not satisfied, they can contact the state regulatory agency for help.

Contact the Insurance Company Personally

Before making a complaint at the state level, start by contacting the insurance agent or the company you have been dealing with. Many issues can be resolved at this level and the insurance company will be interested in keeping an existing customer happy.

Read more: How to File a Complaint Against a Life Insurance Company

The best time to make that call is when you are calm and relaxed. If you don’t feel that you can explain your concerns in a civil manner, you are better off waiting until you have calmed down. Gather any relevant documents before you contact the insurer. In order to help you properly, you will need to give the company representative or agent your policy number.

When you contact the insurer or the agent, explain the situation as simply as you can. Make notes that you can refer to while you are having the discussion, if you think it will be helpful. This step can help you stay on track and ensure that you don’t leave out any pertinent information. Once you have shared the reason for your complaint, tell the agent or the company what you would like them to do to resolve the issue.

If you have made your complaint and the matter is not being resolved to your satisfaction, ask to speak to a supervisor in the customer service department. That person will be able to tell you about the procedures the company has in place for launching an appeal of its decision.

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Start an Appeal

If you choose to appeal a decision made by a long term care insurance company, you may only have a limited time to do so. Be sure to ask the supervisor how long you have to file the documentation to start this process. You will likely be told that you need to notify the company of your intention to appeal in writing, and you will need to find out if you can do so by letter or if there is a specific form that you need to deliver to the company.

Once you have completed any forms that are required to appeal the decision, forward them to the insurance company. Contact the company to find out if there is a particular individual you should send the documents to and to confirm the company address. You should do so in a way so that you have proof of delivery; sending them by registered mail or courier are both good choices.

The insurance company will consider your appeal forms and any supporting documentation carefully and make a decision. If you have been through this process and still aren’t satisfied, you have the option of contacting your state’s department of insurance.

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Contact the Department of Insurance

The Department of Insurance for your state is the agency responsible for licensing and regulating insurance companies. The first step in the process of making a complaint against a long-term care company is to call the Department of Insurance and ask to speak to a long-term care specialist. The Department staff is not “for” or “against” the insurance company; instead they will give unbiased advice to consumers. If the specialist thinks the insurance company behaved appropriately, he or she will say so.

If the specialist feels that the complaint is valid, he or she will send out official complaint forms to be filled out. These forms will be sent to the long term care insurance company, which will be given the option of either resolving the issue or explaining its side of the issue to the Department of Insurance. Insurers must respond to the Department in a timely manner or risk losing their license to sell products in the state. The Department of Insurance will review the matter, if required, to make sure that company has upheld its responsibilities under the insurance contract and is in compliance with applicable laws.

If you need to make a complaint against a long term care insurance company, give the company the chance to resolve the matter first. Then, if you still aren’t satisfied, look to the Department of Insurance for help.

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Read more: Indemnity vs Expense-Incurred Long-Term Care: What You Need to Know

Case Studies: Filing Complaints Against Long-Term Care Insurance Companies

Case Study 1: Delayed Claim Processing

Mrs. Johnson, an elderly policyholder, faced delays in processing her long-term care insurance claim. This caused financial strain due to her need for daily assistance. To address the issue, she filed a complaint against her insurance provider, seeking prompt action and reimbursement for eligible expenses.

Case Study 2: Coverage Denial

Mr. Thompson, a long-term care insurance policyholder, had his claim for assisted living services denied by his insurance company. He disagreed with the reasons provided by the company and felt the denial was unjustified. Worried about the financial impact, Mr. Thompson filed a complaint to challenge the denial and assert his rights as a policyholder.

Case Study 3: Policy Misrepresentation

Ms. Rodriguez bought a long-term care insurance policy relying on the promises of the sales agent. She later found discrepancies between her policy’s coverage and what was represented. Feeling deceived, she filed a complaint to seek clarification and corrective action from the insurance company.

Case Study 4: Inadequate Customer Service

Mr. Lee, a long-term care insurance policyholder, faced difficulties in communicating with the company’s customer service representatives. His inquiries were ignored, and his concerns were not properly addressed, leading to frustration and confusion. To seek better service and obtain the necessary assistance, Mr. Lee decided to file a complaint against the insurance company.

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