Six-and-a-half million Americans are actively suffering from Alzheimer’s disease in 2021. By 2050, it’s estimated that this number will reach 12.7 million. Long-term care insurance is necessary when it comes to providing Alzheimer’s patients with the resources that they need during this confusing time in their lives.

If you have long-term disability insurance and your claim was denied by an insurance provider like Guardian, MetLife, or Unum, our attorneys can help you file an appeal. We handle both long-term care and long-term disability claims and can help you fight to win your claim. 

Continue reading to learn more about Alzheimer’s disease and if it qualifies for long-term care insurance benefits. 

What Is Alzheimer’s Disease?

Alzheimer’s disease is an illness that damages (and eventually destroys) brain cells causing problems with memory, thinking, and behaviors. This illness is aggressive and progressive. It develops slowly over a span of several years. It gets worse over time as the damaged brain cells die off.

Alzheimer’s Disease Symptoms

Alzheimer’s disease presents itself through several different symptoms. Every person may deal with different symptom representations. Usually, someone with Alzheimer’s will struggle with:

  • Memory problems
  • Word-finding issues
  • Mood swings
  • Visual/spatial issues
  • Impaired reasoning and judgment

Those struggling with Alzheimer’s can be aggressive. They can be resistive to caregivers, combative even.

Alzheimer’s Disease Stages

Alzheimer’s disease develops in stages and can range from mild to moderate to severe via stages depending on the severity of the illness. 

Early-stage (mild) Alzheimer’s allows the individual to still be mostly independent. They are still able to work and drive while performing other everyday functions. They might have memory lapses and have trouble coming up with the right word or someone’s name.

Middle-stage (moderate) Alzheimer’s is the stage that lasts the longest. This is where a greater need for care comes into play. Memory problems are more pronounced while adding unprecedented anger or frustration to the mix. Unusual behaviors might also become commonplace. This is the stage where the brain cells are becoming more damaged.

Late-stage (severe) Alzheimer’s is the final stage in the disease. This is where dementia is so severe that Alzheimer’s patients:

  • May no longer respond to their environment
  • Some may be unable to communicate with others (communication may become painful)
  • May no longer move on their own

Patients in late-stage Alzheimer’s may need additional help with everyday activities. It is vital in this stage to continue to engage with them while making preparations for hospice. Helping them maintain dignity and comfort at the end of their lives will make a world of difference to Alzheimer’s patients and their families.

Alzheimer’s Disease Causes

Scientists don’t yet know exactly what contributes to Alzheimer’s in patients who have dementia. However, they know that several factors can cause it to work together to influence a change in brain cells. This might include factors like age, genetics, environment, and lifestyle.

Alzheimer’s Disease Treatment

Because there is no cure for Alzheimer’s, treatment depends on making the patient as comfortable as possible throughout their lives. 

Is It Covered by Long-Term Care Insurance?

Coverage for long-term care is a solution for the families of Alzheimer’s patients because it can help ease the financial strain that comes with their need for in-home or nursing home care.

Long-term care insurance coverage can be given to a patient once they’ve proven that they meet all of the qualifications. The illness must be certifiable through medical reports and clinical evidence. Patients needing long-term insurance care must be chronically ill or have a severe cognitive impairment. Alzheimer’s can include both of these.

Medicare doesn’t cover long-term care for people with Alzheimer’s, but it can help cover some long-term care planning costs.

For benefits to become payable under most long-term care policies, the patient must prove that:  

  • The patient has a “severe cognitive impairment” such that she requires substantial supervision by another individual for her safety or.
  • The patient requires hands-on or standby assistance to perform at least two of the six daily activities listed under the Activities of Daily Living (ADLs)

The Activities of Daily Living refers to an individual’s inability to do the following without assistance:

  • Bathing
  • Continence
  • Dressing
  • Eating
  • Toileting 
  • Transferring

Severe cognitive impairment refers to the deterioration or loss of intellectual capacity required by another person to protect themselves and others from their behaviors. It must be proven by clinical evidence and standardized tests. The cognitive functions are likely to begin deteriorating before the motor skills do.

Why Was Your Claim Denied?

Insurance companies priced their policies too low in the 80s, 90s, and 2000s. As these policyholders are getting older and developing health problems later in life, insurance companies are in a position to lose billions. 

Insurance companies routinely deny claims for long-term insurance care in an ongoing effort to cut their costs. The reasons for denial can include:

  • Technical requirements within policies
  • The decision that benefits holders are getting more care than necessary
  • The decision that benefits holders are in the wrong type of facility

To deny a long-term care claim, insurance companies have records reviewed by clinical consultants who never examine the client. These consultants then deem the case as invalid. These cases may be seen as weak because the psychologist’s and psychiatrist’s diagnosis might contradict a physician’s diagnosis.

For cognitive cases, insurance companies may have these claims reviewed by a medical professional who will decide that there is not enough evidence for cognitive impairments. 

Essentially, it can be a long haul before getting the proper insurance coverage, but your disability claim lawyer can help you with your long-term care insurance claims.

How Can We Help?

Alzheimer’s disease is devastating to the host and their loved ones. There is no cure, and it is fatal, but that doesn’t mean that your loved one can’t be comfortable while they are going through it. When insurance coverage for your loved one’s long-term care gets denied, a knowledgeable insurance attorney will be able to help correct any possible errors and submit proof of cognitive testing on your behalf. 

Our goal is to make sure that you or your loved one gets the insurance coverage promised at the time of policy purchase. Our attorneys are experts. We understand the complexity of insurance policy requirements. We can get your loved ones the long-term care coverage that they need.

Contact Evans Warncke Robinson LLC today for your initial consultation. The sooner you understand what your long-term care policy requires, the sooner your loved one can start receiving the care that they need.