Long Term Care Insurance: Why The Reassessment?

Why the ReassessmentInsurance companies are for-profit ventures, to be certain.  As such, they are constantly on the watch for fraudulent claims. Thus most long term care insurance contracts will provide a right to the carrier to require a reassessment of a claimant periodically.  These can happen as often as once a quarter or once a year… or in some cases never at all.

The point of the reassessment is to determine if the claimant has improved and can go “Off claim”.  Very few claimants will (industry says less than 2% of folks will get well enough to go off claim), but that 2% can mean a large amount of money to the carriers who are paying out millions each year on claims.

So who gets a reassessment?  The most common are folks who claim on issues that might be temporary or from which you might recover (such as car accident, stroke, or cancer).  Issues that are clearly permanent and not ever going to respond to treatment (such as Dementia, Parkinson’s or Alzheimer’s) are less likely to see many, if any, reassessments.  Sometimes long term care insurance carriers will do one reassessment and then not invoke their right to subsequent ones.  Sometimes they will reassess at periodic windows until they can see there will not be improvement.  So the timing and the number of events can vary widely from one claim to the next.

Just know that most long term care insurance claims will see at least one reassessment.  You will have to provide all the documentation again to verify that the claim is still legitimate.  Just be prepared if you are the person filing the claim – it will require another round of gathering up documents and submitting them to the carrier.

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