Millions of Americans have purchased long-term care insurance in an effort to protect themselves from the financial risks associated with long-term care. Unfortunately, when seniors are ready to benefit from their investment, many have difficultly filing their claim and can end up spending months or even years trying to convince their insurers to approve it. Here is what you need to know before you file a long-term insurance claim.

Is it the right time for you to file a long-term care insurance claim?

Before your file your long-term insurance claim, you should make sure you are at the stage where you’re receiving (or are ready to receive) long-term care. If you’re not, it might not be the right time to file. If you’re unsure about whether or not now is the right time to file, you can take advantage of Amada’s complimentary long-term care advising services. Amada will often send a registered nurse to your location to help determine your eligibility. Ultimately, it’s the carrier (via the language of your policy) that determines eligibility, but working with an organization like Amada can help clear up any confusion.

If you you are ready to file a long-term insurance claim, you can file it directly with us!

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How do you qualify for long-term care insurance benefits?

Benefit triggers are the conditions that must occur before you start receiving benefits from your long-term care insurance policy. Most insurers decide when you can start receiving your long-term insurance benefits by evaluating your ability to perform certain “activities of daily living” (ADLs).

Bathing, dressing, using the toilet, walking, and remaining continent are the most common ADLs insurers assess.

Benefits usually begin when you need help with two or three ADLs.

Tip: Policyholders have a tendency minimize ailments and limitations. Unfortunately, this may not help you when filing or reassessing your long-term insurance claim. Request to have an in-person assessment completed by the carrier and include your agency. Together, both the agency provider and carrier can effectively communicate and update the plan of care and skilled nursing assessment.


When will your benefits be available?

Your long-term care policy has an elimination period, also known as a deductible or waiting period. An elimination period is the number of days you must receive home care or nursing care before your policy begins to pay benefits. Common elimination periods are 30, 60, and 90 days. Generally, the shorter your elimination period is, the higher your premium will be.

Get Complimentary Assistance With Long-Term Care

Long-term care insurance policies can be challenging to navigate, which is why Amada Senior Care specializes in long-term care insurance claims. A trained Amada professional can help you get the most out of your policy by helping you understand and verify your benefits. We can:

  • Identify and explain the elements of your policy, including:
    • Elimination period
    • Maximum daily benefit
    • Lifetime benefit
    • Coverage
  • Assist you in completing the necessary forms to file a claim. Amada can ensure you submit all your relevant health information to the insurance company.
  • Directly bill the long-term care carrier.
  • Handle the responsibility of payroll taxes, benefits, scheduling, bonding, worker’s compensation, and general and professional liability insurance.

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Long-term care insurance was one of the best investments you could have made for you and your family’s financial security. When the time is right, let’s make sure you understand your policy and either utilize the benifit to recover from an ailment or preserve your policy and ability to age in place.

“Read This Before You File Your Long-Term Insurance Claim,” Ashley LeVine, Amada Blog Contributor.