Before you call about a long-term care insurance claim

The first call about a long-term care policy tends to go one of two ways. Either you come off the phone with a named next step and a reference number, or you come off it having been told that someone will send a form, without knowing which form, to whom, or by when.

What was in front of you when you dialed makes the difference.

Have the policy itself, not a memory of it

Find the actual policy document, not a renewal letter or a summary page. What you need from it:

• The policy number, exactly as printed.
• The policyholder's full name as it appears on the policy, which may not be the name they use day to day.
• The issuing company, which is often not the brand on the envelope. Policies get sold between insurers, and the company administering it today may be a different name entirely.
• The date the policy started.

If you cannot find the document, the insurer can usually locate a policy from the policyholder's name, date of birth and address history. It just takes longer, and you will need those details ready anyway.

Work out who is allowed to speak

This is a common point that can stop a first call from moving forward. An insurer will generally not discuss a policy with someone who is not the policyholder and is not on record as authorized.

Before you call, find out which of these is true:

• The policyholder can take part in the call themselves, even briefly, to authorize you.
• Someone already holds a power of attorney, and a copy can be produced.
• The insurer has its own authorization form, which is a different thing from a power of attorney and often has to be signed and returned before anything else happens.

If none of those is true yet, that is the call — ask what the company needs in order to talk to you, and get that moving. Everything else waits behind it.

Write down the timeline before you are asked for it

Dates matter. Expect to be asked when the difficulty began, when help started, and who has been providing it. Vague answers get written down as vague answers.

Sketch out, in advance:

• Roughly when day-to-day tasks started needing help, and which ones.
• Any hospital admissions or falls, with dates.
• When paid care started, if it has, and who provides it.
• Which clinicians are currently involved.

You are not making a case. You are making sure the record is accurate the first time, because correcting it later is much harder than getting it right now.

Know what you are actually asking for

"Making a claim" is rarely one action. Ask the insurer to tell you, explicitly:

1. What the claim process is, from here to a decision.
2. Which forms are needed, and who has to complete each one — the policyholder, the family, or a clinician.
3. Whether an assessment is required, who arranges it, and how long it usually takes.
4. What the policy's elimination period is (the industry term for what many people call the waiting period) and, critically, from what date it is counted.
5. What ongoing evidence will be needed once a claim is open, and how often.

Write the answers down as they are given, in the representative's own words, and read the important ones back.

Capture the call itself

Before you hang up, make sure you have:

• The date and time of the call.
• The name of the person you spoke to.
• A reference number for the call or the claim.
• What was agreed would happen next, by whom, and by when.

This feels excessive on call one. It stops feeling excessive around call four, when someone tells you there is no record of a form you mailed three weeks ago and you can say precisely when you were told to send it, and to whom.

The habit worth starting today

Keep one file — physical or digital, it matters far less than being single — with every letter, form, call note and reference number in date order. Not one per sibling. Not one per device. One.

Long-term care claims can stay open for a long time, across changes of staff on both sides. The record you keep can be the only continuous account of what has happened, and the clearest way for anyone joining halfway through to catch up. Once the claim is open, the guides to organizing a long-term care insurance claim and tracking an elimination period pick up from here.

Sources and further reading

• Long-Term Care Insurance — NAIC
• A Shopper's Guide to Long-Term Care Insurance — NAIC (PDF)