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A scheme by a growing number of insurance companies has been uncovered by a group of lawyers in Dallas with the law firm of Powers Taylor, LLP. These lawyers in Dallas have issued a warning about this practice to refuse claims made by seniors under their long-term care insurance policies. The lawyers in Dallas explain that the scheme works like this: Seniors who have faithfully paid their long-term care policies for years, suddenly find their claims are being denied just when they need this insurance the most. The companies are betting that many seniors will not file complaints, and of those who do file complaints, many will die before the claim is settled. Only a very few seek out the help of lawyers in Dallas. The American Association for Justice (formerly the Association of Trial Lawyers of America) uncovered widespread use of this denial scheme by insurance companies, which has been subsequently confirmed by Powers Taylor’s lawyers in Dallas.
The Powers Taylor lawyers in Dallas work with seniors to determine first if the insurance company’s denial is, in fact, a legitimate denial. For example, if a nursing assessment determines the senior does not need assistance to perform “activities of daily living” such as feeding oneself, using the bathroom, or getting into bed, the denial may be appropriate, at least until another assessment is performed. On the other hand, the Powers Taylor lawyers in Dallas have also found that many reasons for denial are simply fraudulent. One example is to give the patient a mini-mental exam that asks questions like, “what day is it?” or “what year is it?” Many patients can easily answer these questions perfectly but still need the medical care they paid premiums to receive. The lawyers in Dallas with Powers Taylor can help you or your loved one dispute the reasons for denial based on such a mini exam. The lawyers in Dallas with Powers Taylor have also found denials based on language in the policy that state the patient must need “continual supervision.” According to the denial, “continual supervision” means non-stop, minute-by-minute care for 24 hours a day. However, Powers Taylor’s lawyers in Dallas have successfully disputed this definition of “continual supervision” and shown that in fact, this term means intermittent, but repeated supervision over a 24 hour period. If you, or a loved one, has been denied benefits under a long-term care policy, contact the law firm of Powers Taylor to set up an appointment with one of our lawyers in Dallas. We may be able to help you fight the insurance company and get the care you are entitled to.