Long term care claim

Based on an article by Attorney Refael Almog

According to current estimates, approximately 40% of long-term care insurance claims are denied by insurance companies. However, long-term care policies can provide significant financial compensation to help cover the expenses of individuals in need of extensive care.

To qualify for compensation, the insured must demonstrate that they have become "dependent" according to one of two criteria: Activities of Daily Living (ADL) or cognitive impairment.

The ADL criterion refers to a decline in the insured's health and functioning, which prevents them from independently performing at least three out of six basic daily activities: standing and lying down, dressing and undressing, bathing, eating and drinking, managing locks, and moving around. The cognitive impairment criterion applies to individuals who experience a decline in cognitive ability and intellectual capacity, manifested by impaired judgment, memory loss (short-term and long-term), and difficulties with orientation which require supervision during most hours of the day. This impairment can be caused by health conditions such as Alzheimer's disease or other forms of dementia. The determination of cognitive impairment must be made by an appropriate medical professional, such as a geriatric psychiatrist.

Insurance companies often reject these claims, arguing that the insured is "not in a nursing-handicap condition," either after sending an "objective" assessor to the insured's home or due to the insured's failure to fully and honestly disclose their health condition in the health declaration.

One of the most crucial steps when facing a long-term care claim is to consult with experienced professionals, such as an insurance agent or a suitable attorney, before filing the claim.

Most importantly – remember not to lose hope and understand that this process requires patience and time.

*It is important to note that long-term care insurance policies which include an exception determined by a health condition expire after one year for individuals under the age of 65, and after six months for individuals above the age of 65.