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Why Was My Lincoln Financial Group Long-Term Care Insurance Claim Denied?

February 29, 2024

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Home » Blog » Why Was My Lincoln Financial Group Long-Term Care Insurance Claim Denied?

We Fight Insurance Companies So You Don’t Have To

Long-term care is a family affair, not just a one-person concern. When a loved one grows older or sick, it affects everyone. Roughly 70 percent of people 65 and older will need some care during their lifetime. Since the out-of-pocket expenses without coverage run about $54,000 per year, many find that long-term care policies are worth the initial cost.

Insurers spend heavily to attract paying customers but when the time comes to cover their healthcare costs, some insurers opt to deny reasonable claims or offer lowball settlements later. Insurance companies like Lincoln Financial know most people will not question their decisions or fight back against unfair claims practices, and they can (literally) bank off of it. Lincoln Financial might have deep pockets and legal resources, but policyholders have one advantage: Wallace Law.

Wallace Law is an insurance dispute firm that helps frustrated policyholders maximize their long-term care benefits when insurers do not deliver on their contracts. Providers like Lincoln Financial Group are among the many insurance companies that use different ploys to deny or limit policyholders’ benefits.

It pays to know more about the claims process. We are here to help you get smarter about Lincoln Group long-term care insurance, filing a claim, overcoming unethical claims hurdles, and protecting your investment.

Exploring Lincoln Financial Group Long-Term Care Insurance Services

As people age, grow sick, or become disabled, everyday tasks like bathing, grocery shopping, eating, or getting dressed get harder. Many people rely on long-term care insurance later on in life as it can provide coverage for nursing home care, home health care, and personal care.

While younger people do sometimes need long-term care plans, this type of care is usually for people 65 and older who cannot care for themselves. In many cases, this care helps them stay independent for as long as possible.

Lincoln Financial Group offers two popular long-term care options, known as hybrid coverage options — MoneyGuard Fixed Advantage® and MoneyGuard Market Advantage.® Any remaining funds in these hybrid plan options will go to the policyholder’s beneficiaries, and the money is tax-free.

Beyond that, Lincoln Financial offers long-term care benefits for people once they reach 30 years of age. (Most insurance companies only begin paying benefits to those at the standard age of 65 years or above.) Lincoln Financial Group lures people in with its affordable care options, but its low customer satisfaction score proves that the company needs to deliver on its promises to pay out claims.

If you’re looking for the payout you deserve, reach out to an experienced insurance dispute firm. Here at Wallace Law, we can help policyholders get paid for legitimate claims when insurers refuse their legal obligations.

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What Does Lincoln Financial Group Long-Term Care Insurance Cover? A Comprehensive Guide

Think of long-term care insurance as “extra” money for support services one might need over time or after developing a chronic illness or disability. Long-term care insurance reimburses a policyholder if they have to stay in a nursing home or rehab center for a short or extended period or if daily assistance is needed at home. People buy long-term care insurance to get quality care without draining their personal or family savings.

Lincoln Financial Group’s long-term care insurance policies cover a variety of care, such as:

  • In-home care
  • Adult daycare or community care
  • Facility care, such as nursing homes and assisted living facilities
  • Hospice
  • Home modifications or durable medical equipment
  • Caregiver training for a loved one (depending on the policy)

Depending on the policy in question, Lincoln Financial Group offers consumers tax-free, long-term care reimbursements, a death benefit for heirs, and a premium return of 80 to 100 percent, subject to vesting. Policies like this often sound good. However, policyholders often do not know if they will get what they paid for until it comes time to submit a claim.

Prepare to File a Lincoln Financial Group Long-Term Care Insurance Claim with These Steps

The need for long-term care insurance can be sudden or take years. Old age, surgery, a physical impairment, or chronic illness might demand increased care for you or a loved one. That can trigger the need for long-term care benefits.

Determine if the Activities of Daily Living Index Is Met

The policyholder, or person who needs care, in this instance, must need help with at least two daily living-related activities due to cognitive or physical impairment to receive benefits.

“Activities of Daily Living” are generally divided into two categories — basic tasks (mobility and personal self-care) and instrumental tasks (complex activities like shopping, managing finances and household duties, and using technology).

More specifically, a checklist of the Katz Index of Independence in Activities of Daily Living might include getting in and out of bed, walking, or using the toilet, and more.

Ensure the Care Plan Meets the Insurer’s Standards

In addition, the policyholder’s care needs must be expected to last more than 90 days and a Plan of Care must be established. Insurance companies may have different standards for what they deem to be acceptable plans and which agencies they feel provide care worth covering. It is possible to activate long-term coverage for a treatment period of fewer than 90 days, but other stipulations must be met.

After the waiting period, Lincoln Financial should start paying out on the claim.

Gather the Necessary Evidence

If you or a family member is ready for long-term care, you typically will need the following documents to get the process started: policyholder statement, attending physician statement, nursing assessment and Plan of Care, provider statement, and authorization to release information.

Wait To Hear Back From the Insurer

After the application and all necessary paperwork have been submitted, the insurance carrier will make a final decision regarding the claim. Most claims can be approved on the first try.

If Necessary: Appeal and Investigate the Denied Claim

However, sometimes insurance companies will stall, deny, or reject claims to boost their bottom lines. Our health insurance dispute attorneys can investigate a wrongly disputed claim so you can focus on your loved one.

Why Does Lincoln Financial Group Deny Long-Term Care Claims?

There are legitimate reasons for claim denials, but insurance companies (like Lincoln Financial Group in the case of Viani v. Lincoln Nat’l Life Ins. Co.,) often find intentional ways to avoid liability and cheat policyholders out of money. This is also known as bad faith claims procedures or commonly used tactics insurance companies use to prevent claim payouts.

Agents might use one or more of these excuses (that sound like legitimate reasons) to rationalize rejecting or denying a long-term claim:

  • Lack of sufficient evidence and medical records to support a long-term care claim
  • Failure to provide proof of loss related to the claim and within the insurer’s timeframe
  • Pre-existing conditions void the claims request
  • Policy lapse due to missing payments
  • Material omissions or submission of false information
  • Policy exclusions

A long-term care denial can financially hurt you or a loved one as costs can add up quickly. You do not have to accept the insurance company’s unreasonable decision. Insurers that request unnecessary paperwork or documentation, drag the claims process out, or refuse to communicate or provide an explanation for denial are likely hindering your payout for monetary gain. An experienced long-term care insurance claim attorney with Wallace Law can help you push back.

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Overcome Hurdles: What to Do if Lincoln Financial Group Denies Your Long-Term Care Claim

Big insurance companies are known to drag out the claims process, so policyholders get frustrated enough to drop the claim or settle for less money than the claim is worth.

Lincoln Financial Group might be engaging in bad faith practices if they:

  • Deny your claim without giving a valid reason
  • Fail to conduct a complete investigation of the claim
  • Offer you less money than the claim is worth
  • Delay or deny decisions on claims
  • Refuse to pay the claim despite the policy coverage
  • Make up excuses regarding the reason for the denial or why the claim is not processed
  • Avoid or delay communication with you
  • Make threatening statements

Many policyholders file an appeal after a claim is denied or rejected to get the insurance company to reconsider the decision. If your insurance company did not play nice the first time, it may deny the claim again in the appeals process.

When the steps fail, it might be time to consider a more effective approach: hiring an experienced insurance dispute attorney. Doing so will likely force the insurance company to take the situation more seriously and help to fast-track a negotiation.

Stop Unethical Long-Term Care Claims Processes: Contact a Skilled Insurance Dispute Attorney Today

Lincoln Financial Group and other well-known industry giants may take advantage of people (like in the case of Grabowski v. Lincoln Nat. Life Ins. Co.) and people who need money for care are often caught in the crossfire.

Hurdles in the claims process are sometimes legitimate, but too often, they are designed to line the pockets of big insurers. Witnessing this in action after years of representing corporations and large insurance companies, attorney Justin Wallace saw the need to help policyholders fight back, and Wallace Law was born.

Wallace Law and our team of seasoned insurance dispute lawyers put insurers in their place and beat Lincoln Financial Group and other unethical insurers at their own game. Our track record includes wins for thousands of policyholders, and with us by your side, you stand a chance against the red tape, confusing run-arounds, and shameful tactics.

Stop Lincoln Financial Group from stealing profits from policyholders. Contact our firm today for a no-strings-attached case review. Our mantra is simple: You do not have to pay if we do not win.


Lincoln Financial Long-Term Care FAQs

Does Lincoln Financial Long-Term Care Insurance Cover Assisted Living?

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How Does Lincoln Financial Long-Term Care Insurance Work?

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How Can I Appeal a Denied Lincoln Financial Long-Term Care Claim?

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