There are reasons to hire a professional to help with your long term care insurance claims. One important reason is the possibility of backfiling, which is confusing to most policyholders and their families.

What exactly is backfiling?

Backfiling is when a policyholder seeks to get a claim paid retroactively, to the point in time when they met eligibility requirements to trigger policy benefits and begin receiving care in a covered setting.

Of course the rules vary upon the insurance company; some allow backfiling up to one year, while others will only allow backfiling between 3-6 months.

To understand backfiling in a more personal way, Jessica Patterson, Claims supervisor at ClaimJockey, LLC tells a story.

“We helped a client who had been in and out of Skilled Nursing and Assisted Living Facilities for a couple of years. The family had attempted to file a claim at one point, but, with all of the non-stop health issues as well as the personal responsibilities of the daughter, the long term care insurance claim fell through the cracks.  Although the policyholder had received care in five different care communities, the family said they had no one to help them through the claims process – so they had given up! When they found ClaimJockey, they were relieved. However, it hadn’t occurred to them that they might recover money they had paid out over the last couple years. To make matters worse, the policyholder was on the verge of being evicted from the facility because the family had run out of money! ClaimJockey was able to backfile for a full year on behalf of this family, and here’s what happened: the elimination period was satisfied, and the family received 2 checks totaling $46,000! Of this amount, $17,000 was for a refund of premium that had been paid when the claimant was actually eligible to have her premium waived.”

“This is a way to give back to those who have paid years of premium dollars. These are benefits that we bring to their attention, then backfiled to put the benefit dollars in our client’s wallet.”

Our team of New York estate planning attorneys, elder law attorneys, and special needs attorneys use our knowledge and experience to answer your questions. We promise to answer any question with a straight answer. If you still have questions about backfiling feel free to contact us!