What are the rights of a persons whose application for long-term care insurance has been denied?

Question

what are the rights of a persons whose application for long-term care insurance has been denied?

Answer 1

You may have the right to enter your state's high risk pool, if they have one. Some states have special plans for people who can't get coverage in the private market. The premiums are a lot higher, but at least it is some coverage. While many states have this for health insurance, few offer it for LTC.

For people who can't get long term care insurance, unfortunately, the alternative is public assistance, which means you will have a tougher time trying to save your assets for purposes of leaving them to your loved ones, instead of paying for your care.

Answer 2

The answer depends on the reason(s) for the declination.

Several answerers have written that an insurer doesn't have to insure you; this is not always true. NO insurer is permitted to decline a risk due to an arbitrary, capricious or unfairly discriminatory reason. I believe this is the standard in ALL states. If these laws are violated, the insurance commissioner in the applicant's state has the ability to order an insurance company to issue the policy. Again, this is entirely dependent upon the finding that a violation has occurred.

In order for the declination to be legal, your health problem MUST be proven, by objective actuarial data, to pose a higher risk to the insurer than its underwriting guidelines will accept. For example, in my state, an insurer was ordered to issue a previously declined policy to a man who had an inherited form of mild anemia. Because actuarial data proved there is no increased morbidity risk, the insurer's underwriting guideline was proven to be arbitrary and capricious. The insurer was also ordered to cease using this underwriting guideline. This was a dramatic case and it's not very common that this will happen; but it does occasionally happen because some insurers believe they answer to no higher authority regarding the risks they take.

So the first step to finding out whether you can do anything is understanding why you were declined. If you disagree, you and/or your doctor may send a letter of appeal to the insurer and ask for reconsideration. If it upholds its decision, send a complaint to your state's insurance commissioner and ask that it investigate the declination. During the investigation, an investigator will obtain a copy of the underwriting guidelines and should also get a copy of the actuarial information that supports it. Most states also offer an administrative hearing if you disagree with the commissioner's findings.

I hope this helps.

Answer 3

Due to the new HIPPA Privacy Act, the Agent that took the application can not find out and inform you. Depending on your State, a letter may be sent giving the exact reasons. They may have just applied with a company new to Long Term Care (last 10 years), and are very conservative with who they will issue a policy to. Usually, I know before ever taking the application why someone would be denied. If I have any questions, I will apply for a high risk policy and then take baby steps. Now that a denial has been recorded, it is probably on the MIB (medical information bureau) and other Long Term Care Insurance Companies will certainly consider that before getting medical records. If you do not get a letter, you have the right to contact the Home Office of the Insurance Company in writing, they will send the reason to the doctor and then your doctor will inform you. Message me, tell me what medical problems you may have, and I can tell you which route go pursue. Also, let me know which company you applied for.

Answer 4

Do you know the reason you were denied? If so, you really have no other rights. If not, you can write the company and ask for an explanation and they must either tell you or your doctor. If it is a reasonable reason, you again have not rights. The company is really in charge. They can insure who they want and if they don't want you, they don't have to insure you. You can ask another company about their underwriting rules to see you someone else may insure you.

Answer 5

Well, none. Insurance companies don't HAVE to insure ANYONE. They have the right to turn down anyone they want.

The only "right" I know of, if they use credit score to affect eligibility or rates, they have to tell you that up front, and if they refuse to give you insurance due to information received from the credit report/score, then they are required to advise you of that, and tell you where you can get a free copy of your credit report.

Answer 6

No rights. Declined application means that the applicant is not of standard risk.

Answer 7

It also depends if this policy was a guaranteed issue (approval) or if there was undewriting involved.... If there is underwriting involved then they have to tell you where they got thier information (you, your doctor, ect)

Answer 8

You have the right to know exactly why it was denied and dispute the cause if it is incorrect.

Answer 9

you can find out way and appeal thier opinoin.

But a company does not have to insure you, they are in business and if you don't meet thier underwriting guilde lines they don't have to insurae you