Page Reviewed / Updated - May 2016
As individuals grow older, they become more susceptible to accidents and injuries. As a natural part of the aging process, vision and hearing deteriorate and reflexes and reaction times slow down which all lead to an increase in injuries among the elderly. Consequently, the elderly experience increased medical costs; injuries and accidents may require nursing home care, durable medical equipment, home modifications, rehabilitation, physical therapy and pain medication. If an individual is injured in an accident or fall, they may be eligible for assistance or compensation for the additional medical costs they incur.
Aging individuals are also slower to recover from injuries. In fact, many never fully recover their capabilities. Slipping and falling results in almost a quarter million broken hips every year in the US. These life-changing events may entitle individuals to settlements that provide for personal care assistance with their activities of daily living and help them remain living at home or afford them the option of moving to an assisted living community.
When elderly individuals are injured and have resulting medical and personal care expenses, they are entitled to fair compensation from insurance companies. Insurance, whether it is Medicare, business, property, or other type of insurance, exists to assist individuals when there are accidents. It is not uncommon for elderly individuals to be unaware of insurance's obligations and often times, companies will deny their claims for assistance. Elder law and personal injury attorneys, as well as advocates from the state, can be very helpful in these cases, as they are knowledgeable about insurance company responsibilities and how best to work with them to receive the maximum benefits which are due.
Injured individuals may be due compensation from their own or other insurance for medical care, nursing home care, and the non-medical, personal care they receive at home or in assisted living. In addition, they can receive compensation for durable medical equipment, home modifications necessary to accommodate for their long-term injury, and additional compensation for the disruption to their lives.
Depending on the location in which an injury or accident occurred and the type of injury, an individual may be entitled to compensation or assistance. To learn more about specific types of injuries and possible compensation, click on the links that follow.
Working with an attorney to receive fair compensation for injury is a fairly simple matter, and fortunately, most attorneys who work in this area charge their clients on a contingency basis. This means that they do not charge their clients any money to start a suit or if they lose. Clients are only charged if the attorneys are able to reach a settlement. The attorneys will then take a percentage of the settlement amount, usually around 30%. Though this percentage may seem high, this method of payment works to many elderly individuals' advantage as they are not required to put out their own money and they only pay if they receive a settlement.
While there is no risk to using an attorney to receive fair settlement from insurance companies, individuals should be aware of the time it usually takes to reach a settlement and receive compensation. In the best case scenario, the time it takes to find and meet with an attorney, file suit, negotiate settlement, and receive compensation can be 2-3 months. However, because insurance companies will drag their feet in making a settlement, and there is only so much an attorney can do to force the issue, it is not uncommon for individuals to wait as long as 6, or even 9 months, before they receive any payments, especially when negotiating with Medicare.
The process begins by contacting an attorney. Rarely is there a charge for the consultation (or until a settlement is reached). During the initial consultation they discuss the situation, answer questions, and decide if they will take the case. If both parties decide to proceed, a deeper conversation ensues and the attorney collects and prepares the necessary documentation. The attorney then makes contact with the insurance company and weeks or months of negotiation take place. This is a period where there is limited communication with the attorney and many individuals become frustrated with the waiting process. However, often times the prolonged negotiation means the attorney is fighting for a higher settlement amount, so it can pay to be patient. Finally, when a settlement is reached, payment is usually made directly to the attorney who immediately pays the individual the settlement amount, minus their fees.
Each state has a Protection and Advocacy Program. These organizations often provide legal assistance to protect the rights of insurance holders when their policies refuse to pay what the policyholder is due. Learn more here. Another option, should an injury have occurred while an individual is in residential care, is to contact your state's Long Term Care Ombudsman.