Should We Use Cognitive Impairment or Activities of Daily Living to File a Claim?

Alphabet Soup of Long Term Care Policies

Should we Use Cognitive Impairment or ADLs (Activities of Daily Living) to Claim?

Yes. That is always our answer when we are asked this: yes, use them. Both.

If you have a long term care policy claimant who is having some dementia and also needs help with activities of daily living on a long term care claim – use every bit of arsenal you have on the claim forms. Contracts read as if this is an “OR” situation…one OR the other. But life isn’t an “or” proposition most of the time. If you have multiple things going on, report them all. They won’t hurt your case and they may help it.

To give you an example, we recently had a long term care claim come thru where the family said there was progressive dementia and we clearly had medical need for two of the six activities of daily living (toileting, and continence – to see a full explanation of activities of daily living see THIS blog). We could have filed the claim on those two activities of daily living alone. However, we have too often seen things go sideways when you put thru the bare minimum requirements for a claim. We counseled the family to take their Mom to the Doctor and get a standardized cognitive screen performed (there are many of these: Six Item Screener, MMSE, SLUMS, etc). We also warned them that they should try to get their Mom to the Doc when she was at her worst (say, late in the day when she was tired rather than early in the morning when she was rested) so that she would perform at her worst, not her best on the test. This is one time you truly want to flunk the test as bad as you can!

By having both the cognitive impairment and the Activities of Daily Living (ADL’s) on the claim – and having clinical evidence of the severity of cognitive impairment – you build a stronger case for a long term care claim than if you have only one (say activities of daily living only).

So if you are wondering which to use, the answer is “yes” – use every item you can. Just be certain all your documentation mentions all the same items. But that is another conversation about the importance of MATCHING documentation. See our other blog on that HERE.

 

 

Some Additional Links to help you with your long term care claim journey

 

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