Long-Term-Care Claims: Avoid The Obstacles

Filing a claim can be an ordeal, but these preventive measures will streamline the process.

- Kimberly Lankford

Buying long-term-care insurance is usually a smart way to protect your finances and your family from the potentially massive cost of care. But after paying premiums for years, you don’t want the insurance company to hassle you—or your children—when you submit a claim.

Even if the insurance company ultimately pays out, the claims process can be slow and complicated. It’s easy to make mistakes that could delay or jeopardize the payout. And the person who bought the policy ordinarily isn’t the one who submits the claim.

One frequent sticking point is the waiting period. Some policies have a zero-day waiting period for home care and a longer waiting period for nursing homes and assisted living. The fine print can even trip up the experts. Jennifer Burnham-Grubbs is the cofounder of Quantum Insurance Services, in Los Angeles. Her father-in-law, Carroll Lam, who recently died at age 84, bought a policy when he was in his early fifties. After a heart attack, he needed help with several activities of daily living. His wife, Donna, 72, had been providing the care, but it was getting increasingly difficult, and they realized that his long-term-care policy could pay for professional caregivers.

The policy had a 60-day waiting period. Jennifer thought that meant it would start to pay out 60 days after the insurer said he qualified for care, even if Donna was the one to care for him. But the policy only counted the weeks when he received at least two hours of care from a caregiver who was certified by the state. “That was eye-opening,” says Burnham-Grubbs. “Now that we’ve been close to it, we see the nuances firsthand.”