The Long Term Care Claim Game

Long Term CareClaim Game

The Claim Game

I hear it over and over – people have one of two experiences with their claim for long term care insurance:  either it was “no problem” or it was “such a nightmare.”  There really isn’t anything in between.  The “no problem” people sent in one form, had one interview and started getting money.  The “such a nightmare” people sent in form after form after form, had an interview, gathered more documents and sent those in, wept into their hands at their desks, and maybe –finally – hopefully started getting money.  Or they didn’t….

What is the difference?  Well it could be a couple of different things

  • The carrier you own: some carriers do more of the paperwork process on the claim than others do.  If you have a carrier that handles the bulk of the load on documents you may see a seamless process (it has other potential pitfalls – but work load won’t be one of them).
  • The reason for care: in our experience a dementia diagnosis is generally more clinically defined in medical records and so less subject to interpretation than a need for help with activities of daily living.  ADL-based claims often get more paperwork and have more tribulations than cognitive impairment claims.
  • Your care provider: some care provider will allow you to “assign benefits”.  This means that you are giving all the benefit/money from the policy to the care provider.  When that happens the care provider is more motivated to do all the paperwork on the claim for you.  There are very few care providers in long term care that will accept assignment of benefits.  But if you find one, you are probably going to be in the “no problem” group.

If you are in the “no problem” group – count your lucky stars!  You had the equivalent of a 1040EZ tax situation.  Most people will be a more complex filing situation.  Tackle it yourself….or take that from your plate by hiring a professional service like ours.  It really IS like taxes – lots of paperwork with lots of money at stake.  If you hire a professional for your taxes, consider hiring a professional for this “claim game” as well.


Some other long term care links to help you.

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