An explanation of the stages in handling a long-term care insurance claim, the factors affecting how long the assessment takes, and an organised way to track the process.
There is no uniform duration for every claim
How long a claim takes depends on the policy, on how complete the material is, on whether an assessment or further documents are needed, and on how the handling body works. It is therefore wise to be wary of any promise of a fixed completion date.
You can, however, reduce uncertainty through an organised file, proof of delivery and follow-up based on official correspondence.
The stages that affect the timeline
The process is not always linear, and some stages can repeat when information is missing.
- Locating the policy and the appropriate forms
- Preparing the claim and the documents
- The material being received and confirmation of receipt
- Requests for further documents, if needed
- A functional assessment or another examination, depending on the procedure
- Receiving a decision and checking the grounds given
Common delays you can reduce
A missing document or an unreadable file can stop the review. Answers that are inconsistent between the form and the records can also create a need for clarification.
- Using an old or unsuitable form
- Missing policy details or required signatures
- Documents that were not received or were sent without confirmation
- A general description that does not explain function
- Not answering a request for further documents in time
How to keep track
Keep a list with the date, the action, the document, how it was sent and the reply. If you receive a phone call, note the representative's name and the substance of the conversation, and then rely on the written instructions and official documents.
When there is no progress, or a refusal arrives
First establish the official status and whether material is missing. If a decision has been made, read the grounds and the deadlines before deciding whether to complete documents, request a review or take another route. In a legal dispute, approach a suitable professional.
Frequently asked questions
How long does it take to get an answer on a long-term care claim?
There is no uniform period. It depends on how complete the submitted material is, whether further documents or a functional assessment are needed, and the insuring body's procedures. Some companies publish claim-handling timelines on their sites.
What delays a long-term care claim most?
Usually a missing document, an unreadable file, an out-of-date form, a discrepancy between the form and the records, or not answering a request for further documents within the deadline.
How do we check the status of the claim?
Using the claim number issued at filing, through the insuring body's official channel. It is worth noting every conversation, but rely on the written instructions and documents.
What do we do when there is no answer for a long time?
First make sure all the material was received and that no request for further documents has gone unanswered. Then approach the insuring body in writing and keep proof of delivery, so there is a record to follow up on.
Can a claim be speeded up?
There is no way to guarantee it, but a complete and organised file, prompt answers to requests for further documents and consistent record-keeping considerably reduce the number of rounds and the delays.
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.
