A practical guide to filling in a long-term care insurance claim form: where to obtain the right form, which fields sink claims, how to word the description of the condition, what to attach, and how to confirm everything was received.
First of all: the right form
It sounds trivial, but this is one of the commonest causes of delay. Families download a form they found in a search, or use one saved two years ago.
The rule is simple: always from the official source, and always according to the body that actually administers the cover. Where a group cover through a health fund is involved, the form may be that of the insurance company managing the arrangement rather than the fund's own.
If you are not sure which body handles it, that is the first question to resolve before you fill in anything. Sending a file to a body that does not handle the case wastes weeks.
The fields that sink claims
Most of the form is technical detail. But there are a few fields where imprecise wording is expensive.
- The date the long-term care condition began — not the date of diagnosis and not the date of filing. Think hard about the correct date and support it with a document
- The description of the functional condition — the field that decides. See more on this below
- Details of the help required — who, with what, how often
- Place of residence — home or institution, including the date of any move
- Questions about additional covers — these must be answered truthfully and in full
- Details of the person making the declaration — who is filling in the form and in what capacity
How to word the description of the condition
This field is usually too small, and the family writes a line or two in it. That is a missed opportunity, because it is the most significant part of the form.
The principle: do not describe the illness, describe the functioning. Not "suffers from advanced dementia" but "cannot shower without full assistance, her daughter comes every morning to wash her; does not recognise her medication and does not take it without direction; left the house twice and became disoriented".
If there is not enough room on the form, attach a separate sheet and note on the form "see appendix". That is an entirely accepted practice and is preferable to compressing the information.
Before sending: a ten-minute check
Before you send it on, it is worth going through the file as though you were seeing it for the first time and did not know the family.
- Have all the fields been completed, with no field left blank
- Are all the signatures in place, including on inner pages
- Are the dates consistent between the form and the documents
- Does the functional description match what the medical documents say
- Are all the files legible and clearly named
- Has a complete copy been kept, identical to what was sent
After sending
Keep the delivery confirmation and the claim number. Without them there is effectively no way to follow up or to prove what was sent and when.
It is worth confirming within a week or two that the material has been received and attached to the right claim. Files do sometimes get sent and never reach their destination, and the family discovers this only after two months of waiting.
Open a simple tracking diary: the date of filing, the confirmation of receipt, every request for further documents and the date it was answered. It will save a great deal later on.
Frequently asked questions
Where do we obtain the long-term care claim form?
Always from the official source of the body that actually administers the cover. Where a group cover through a health fund is involved, the form may be that of the insurance company managing the arrangement rather than the fund itself.
What do we write in the field 'date the long-term care condition began'?
Not the date of diagnosis and not the date of filing, but the date on which the dependency actually began — and ideally one supported by a document. That date may affect the period for which the benefit is assessed.
There is not enough room to describe the condition — what do we do?
Attach a separate sheet and note on the form 'see appendix'. That is an accepted practice and far better than compressing the information into a single line.
How do we word the functional description?
Describe functioning, not illness. Instead of 'suffers from dementia', set out what she cannot do, who helps, how often, and what happens when there is no help, with concrete examples.
What do we do after sending the form?
Keep the delivery confirmation and the claim number, confirm within a week or two that the material was received and attached to the right claim, and open a tracking diary with all the dates.
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.
