A guide to a long-term care insurance claim where the insured person is bed-bound: why even an unmistakable condition needs orderly documentation, which activities to set out, what to ask the treating team for, and how to handle the question of when the condition began.
Even an obvious condition has to be documented
When someone is bed-bound, the family rightly assumes the condition speaks for itself. And so, paradoxically, it is sometimes precisely in these cases that the documentation is especially thin — a short medical document is sent, on the assumption that what is happening is obvious.
But whoever reads the file on the other side does not see the bed. They see documents. If those do not contain an explicit description of the activities, a gap opens between the reality and what has been recorded.
The advantage in a situation like this is that the description is simple to write — no nuance is needed. It just has to be written.
Set out activity by activity
The definition in the policy refers to specific activities. So the description has to go through them one by one, even where the answer is the same for all of them.
- Bathing — whether it is carried out in bed, who carries it out and how often
- Dressing — who dresses them, whether two people are needed
- Eating — whether feeding is needed, whether there is difficulty swallowing or alternative nutrition
- Mobility — whether there is any ability at all to move in bed
- Transfers — whether it is possible to move them to a chair, and by what means
- Continence — whether it exists, and what care is required
- Changes of position — how many hours apart and who carries them out
The extent of the assistance and who provides it
Beyond the activities themselves, it is important to describe the whole arrangement: how many hours a day someone has to be present, who is there, and whether more than one person is needed for particular activities.
Moving someone from bed to a wheelchair, for example, sometimes requires two people or a hoist. That is a fact which demonstrates the extent of dependency better than any general description.
It is also worth setting out the equipment: a nursing bed, an air mattress, a lifting hoist, an adapted wheelchair. Each of them indicates the level of dependency.
The date the condition began
When someone becomes bed-bound, there was usually a process leading up to it — a hospital admission, a fracture, a stroke, or a gradual decline. The date on which significant dependency began may be much earlier than the date of filing.
Since the date affects the period for which the benefit is assessed, it is worth looking for earlier documentation: when the nursing bed was ordered, when the carer's employment began, when the nurse visits started.
The information on this page is general and does not constitute medical, legal or insurance advice. Diagnosis and treatment are carried out by a qualified medical professional only, and entitlement is determined according to the definition in the policy and the documents relevant to the case.
Frequently asked questions
If the condition is completely obvious — is detailed documentation still needed?
Yes. Whoever reads the file sees documents, not the reality. Even in an unmistakable condition you have to set out activity by activity, otherwise a gap opens between the condition and what has been recorded.
What do we set out when the insured person is bed-bound?
Each activity separately — bathing, dressing, eating, mobility, transfers, continence and changes of position — including who carries it out, how often, and whether two people are needed.
Is the equipment in the home relevant?
Very much so. A nursing bed, an air mattress, a lifting hoist and an adapted wheelchair each indicate the level of dependency, and it is worth setting them out and attaching supporting documents.
How do we establish when the condition began?
By looking for earlier documentation — when the nursing bed was ordered, when a carer's employment began, when nurse visits started. The date affects the period for which the benefit is assessed.
Official sources for further checking
This is general information and does not replace personal medical, legal or insurance advice. Eligibility is determined by the documents and rules that apply to each case.
