What can we do regarding a denial on a long term care policy?

Question Details: A relative is in a memory care unit. We were told by the physician on staff and an independent doctor that she has severe cognitive issues and cannot live on her own or in their assisted living section. We then considered moving her back to her home and had her evaluated for a nursing service to come for part of each day. Since she is currently in a locked memory care unit, she was given a BIMS (Brief Interview of Mental Status). The score range is from 1-15. She scored a 4 with 0-7 being severe impairment. We were told that she would need 24/7 care. She was interviewed by an independent doctor sent by the insurance company who said it is not severe enough; it has refused to pay on her long term care policy. Do we have a case to appeal?

IMPORTANT NOTICE: The Answer(s) provided above are for general information only. The attorney providing the answer was not serving as the attorney for the person submitting the question or in any attorney-client relationship with such person. Laws may vary from state to state, and sometimes change. Tiny variations in the facts, or a fact not set forth in a question, often can change a legal outcome or an attorney's conclusion. Although AttorneyPages.com has verified the attorney was admitted to practice law in at least one jurisdiction, he or she may not be authorized to practice law in the jurisdiction referred to in the question, nor is he or she necessarily experienced in the area of the law involved. Unlike the information in the Answer(s) above, upon which you should NOT rely, for personal advice you can rely upon we suggest you go to AttorneyPages.com and retain an attorney to represent you.