This week, I visited with a respected elder law attorney who was skeptical of LTCi (Long-Term Care insurance). His attitude was that LTCi is a necessary evil. He was cynical of LTCi’s ability to pay when needed.
This highly trained, successful, experienced professional must not be an isolated case. I figure if the whole world understood that LTCi pays easily, with little effort when the claim is submitted correctly, there might be a stampede of prospective clients at my front door.
For years, LTCi has suffered this kind of bum rap. Co-incidentally, I’m doing an increasing amount of clean up of incorrectly submitted LTCi claim forms.
What I figure is happening is that the first wave of LTCi claims are starting to hit. Providers, be they home health care agencies, assisted living and other facilities, or doctors offices, are not familiar with LTCi claim forms. The claim forms get submitted incorrectly, and are then denied.
In the case of my lucky clients, I am still present and accountable to them years after they bought their policies. When I find out about a legitimate case that has had a denied claim, I advocate for my client. I find out where the mistake or misunderstandings occurred, I fix them, and I get the claim paid.
On behalf of the LTCi industry and many needful clients, who have placed their faith in their LTCi and dutifully paid their premiums year after year, I am sorry so many of these situations have occurred. These situations cause unnecessary stress to the insured and their families, and they do not help LTCi’s undeserved tarnished image.
The irony is that LTC insurance has the most straightforward language defining ability to collect in perhaps in the entire insurance industry. Like very little in life, the language determining eligibility to file an LTCi claim is black and white.
Policy holders are entitled to collect from LTCi in one of two circumstances: they need at least standby assistance to perform 2 out of 6 Activities of Daily Living, or they suffer cognitive impairment severe enough that they may fall in to harm’s way if they are not continuously supervised. There are no gray areas. This language is universal to all LTCi policies.
There is additional language that often foils LTCi claims. The need for care must be “chronic” in nature: reasonably expected to last 90 days. This means that if you’ve had, for example, a successful, routine hernia surgery, and you need care for a few days only, you will not be entitled to collect from your LTCi. This area of LTCi claim forms is where I see the most mistakes.
I estimate that I have had at least 300 LTCi claims. Every claim I know of has been paid, even though it has sometimes been necessary for me to assist, not due to the difficulty of filing a claim, but simply because of clients’ and providers unfamiliarity with the LTCi claim process.
