Some people in Florida who have long-term care insurance could have their claims denied if the insurer rules that it is related to a preexisting condition. This happened to a woman in Louisiana who had only a 1 percent chance in 2012 that breast cancer would return after undergoing chemotherapy, radiation, a double mastectomy and removal of her lymph nodes.
Scans over the following five years continued to indicate that the cancer had not returned. However, in early 2018, she developed lower back pain. An MRI detected a metastatic cancer in her spine.
The progress of the cancer meant she was unable to work, and she needed emergency surgery. However, she was denied long-term disability payments when she applied through her company policy. The insurance company ruled that because of her annual oncology follow-ups and a preventative medication she took, she was not eligible for benefits.
The woman said the denial had taken its toll. The stress of the financial side of things was as difficult as dealing with the cancer itself. The insurance company would not comment on the denial, but the woman’s employer was working with her to try to get the disability claim paid.
People who have been denied long-term care insurance claims might want to consult an attorney. They should not assume that a denial is the final word on the subject or that there is no recourse available. An attorney may be able to evaluate a person’s individual situation and make recommendations for next steps. Preparing an initial claim or an appeal can be overwhelming, particularly for a person who is dealing with the stress of a major illness, but an attorney may be able to help with this process.
Source: WBRZ, “Stage 4 cancer patient denied disability insurance,” Chris Makamoto, Erin McWilliams 9/18/2018