How to Fill Out An Application For A Long Term Insurance Claim

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This is the Truth Network. Welcome to Finishing Wealth, brought to you by CardinalGuide.com, with certified financial planner, Hans Scheil, best-selling author and financial planner, helping families finish well for over 40 years. On Finishing Wealth, we'll examine both biblical and practical knowledge to assist families in finishing wealth, including discussions on managing social security, Medicare, IRAs, long-term care, life insurance, investments, and taxes. Now, let's get started with Finishing Wealth. Finishing Wealth is a general discussion and education of the issues facing retirees. CardinalGuide.com, Cardinal Advisors, and Hans Scheil CFP sell insurance. This show does not offer investment products or investment advice.

Welcome to Finishing Wealth, with certified financial planner, Hans Scheil, and today's show kind of different, but I love it. How to fill out an application for a long-term insurance claim. And so, as you may know, when you're filling out insurance claims, you know, the insurance companies it, you know, they're, they're fairly complicated and you want to make sure you get this stuff right.

And this is no place to fall into a loophole. Well, the thing that immediately occurred to me when it comes to long-term care is that we're all looking for this, the ultimate long-term care program, obviously, is that we want to end up, you know, with Jesus in heaven. And so this is no place to not know what's on the application. And so, you know, we got to talk about that briefly that, you know, the question that, that you often ask someone if they, you know, do you know if you die today that you have the ultimate long-term healthcare program that you'll end up in heaven and that Jesus won't say, I never knew you. And, you know, a lot of times they say, well, I'm a good person or, you know, I did good. I, you know, well flunk that, that won't get you across the border. Because, you know, what's, what's happening here is that Jesus paid him across the application fee.

He, he, he, he did it all. And just like if you're struggling with your long-term care, you know, you might want to call Hansel in the case of struggling with the application of getting into heaven. You got to know a guy and the guy you got to know is Jesus, right? And you got to know that, that he is God and he did die on a cross for you.

And it is by his blood that he purchased your righteousness and to know that in your heart and to ask him to come into your heart and to be born again and to get that new life in him and be willing to surrender our life to him and to walk with him in, in joy. That's, that's what's on the application. I thought they would cover that quickly.

Because, you know, of all the applications that we don't want you to miss out on, I mean, this is the one that obviously is, is very, very critical that at the point in time when you're there, like you got to know a guy and the guy you got to know is Jesus, Hans. I want to go kind of to the roots of this, like why we're doing this show and why we're talking about long-term care claims. And it's not going to surprise me that a few people are not going to be too happy with me talking about the long-term care claim problem that exists and always has existed. And what that is, is these insurance companies just don't want to let loose for their money. When the person is laying in a nursing home or an assisted living or they're, you know, I mean they just, they just don't. I mean that's, that's insurance companies, that's who they are.

And there's a, there's a subjective element to these claims, which it's really around the word substantial. So let me just read what an actual policy says. It says that the person filing the claim or the policy owner is unable to perform, comma, without substantial assistance from another individual, comma, two activities of daily living.

And unable to do this for a period of 90 days. And then it goes on and lists the six activities of daily living, which are bathing, continence, dressing, eating, toileting, and transferring. I mean who wants to talk about that this afternoon? And getting in the situation where they can't do two or more of those things. I mean, so just by its nature, people don't want to go over this subject. They don't want to talk about it. They don't necessarily like to see me coming. And so then what really made us do this show is we've just had a couple of clients lately, more than a couple, that specifically they have lots of resources, they got lots of money, planned well for their retirement, and they just aren't buying any long-term care insurance.

In fact, they're not even talking about it any further with us. And it's due to an experience this one lady had with trying to file claims on her mother, who's now deceased. And she, in her eyes, got the runaround.

And it was the runaround. I mean, it's just back and forth from the insurance company, trying to get the doctor to say this or the social worker about how much she needs care and when she needs care. And she's sitting there with these insensitive people that she's dealing with at the insurance company, and she's the daughter of going through a really bad situation with her mother in the end of her life, which was a long period. And she just had a perception that these people were just applying Catch-22. And she got so upset about it, she's just, she's not buying any of these policies.

There's just no way, no way. And so I just kind of put it aside and really just didn't have much more to say, other than I did circle back in the end of our meeting and I said, did they ultimately pay on your mother? Did this insurance company, after she wasn't as upset about it, and the answer was true.

They did. And in most situations where people tell these horror stories with the insurance company, the insured finally got paid. I mean, they, and so it's hard for me to refute anything she's saying. And I'm not going to do that with her.

I am going to go up and meet with her up in the mountains and maybe play a little golf and kind of get to know each other a little bit better with she and her husband. And then I'm going to impress upon them is that the big losers in this deal, where she's gotten to are them, because they're going to be left without long-term care insurance. And I know they are taking comfort in the fact that they have the money to pay for it.

But these people, they don't have any children. And when they started the interaction with us, what they put down on the form is they want to develop a trustee or a third-party trustee to take care of them when they can't take care of themselves or to at least take care of their financial matters. And so she even described the situation that they might be in, where they don't have anybody to look after it. And then at the same time, they think this person is going to be able to spend their money appropriately to care for them.

So I'll let you talk for a minute. Because what we've learned, or what I know, is in my father's own case, as my father was reaching that age that, yeah, he had the money for the long-term care or for the home health care that he needed. But when he heard what the prices were, just absolutely no part of that. And so it's the family in most cases. Of course, in this case, they don't have any kids. But you're left there trying to figure out how to take care of your family member. And I'm actually in that situation right this very minute, as my mother-in-law fell the other day. And she's in her 80s. And I'm watching my wife just, she can't do anything. I mean, she can't go to the bathroom. She can't do this.

She can't do that. And Tammy is with her 24-7. And there's no relief. And it's hard on the rest of the family. It's hard on the family. It's hard on the family. It's hard on the rest of the family. It's not just hard on the patient.

It's hard on everybody, as the case may be. So yes, one of the cool things about this video that I saw that Hans and Tom did there at cardinaladvisors.com as they went through this process was they said, hey, whether you bought the policy from us or not, if you're struggling with an insurance company with a claim, call us. And time and again in the stories that I heard, the people got paid the claim, but it's just a matter of understanding the process and getting the I's and the T's dotted in the right place, right, Hans? Well, it is.

And suffice to say, I have a lot of experience with this. And I went through this with my own mother, with the insurance company, pretty much saying no to the home health care benefit on my mother's long-term care policy that I sold her and paid for in the first year or two. You know, I talk about that in my book, of the policy. And the insurance company that I used to work for just said no. And what they were really saying is your mother does not qualify for the home health care.

She doesn't meet with that standard of care that I just read earlier. And then, of course, I got them to look at it differently, and then they ended up paying the claim. And I've helped tons of clients with companies I didn't use to work for, just getting out the policy, reading the qualification of care, and then going to the professionals and just getting them to certify what the deal is and getting the people's claim paid. So it's actually, once you get through to somebody that knows what they're doing on the insurance company's end, and on our end, this is actually pretty easy to fix.

Yeah, I love the way Tom walked us through it. And you have this board on the video that shows the two different ways to walk through that application of folks that are not cognizant, obviously, or like Alzheimer's and that kind of thing, where they require somebody to look at them all the time, or the other where they needed those six areas of life, bathing and dressing and continents and those kind of things. And it's helpful to know that what Tom said was that it doesn't necessarily have to be filled out by a doctor when it isn't.

It's going to be a whole lot easier to get it done right, right? Well, it is. And so for starters, what's on the board and on the video, if you want to go to YouTube and look at it, is the definition of care in the standardized policy. These things have been standardized since the late 90s. So in other words, if your policy or your parents' policy, it's a long-term care policy, and it was purchased sometime in the late 90s or more currently, or the last 25 years, then this is their definition. But if their policy is older than that, it's not too far from this. But what I wrote on the board, I just pulled out of one policy, but it's exactly the same in all the policies, because the insurance departments really put the clamps on the insurance companies that this definition of care or this qualification of care needs to be written exactly the same in all the policies.

And if they're 25 years old or newer, this is exactly what it is. And I really want to talk about this. Even if it doesn't apply to you right now, this is beneficial to just get a few things planted in your mind, either for your own policy to tell your kids, or for you may have parents that have insurance, or aunts or uncles, or somebody in your church that's a little older that has this, and they may actually need your help or you to get to me to help them when they're in this situation. All right, we got to go to a break. So we want to remind you, this is brought to you by CardinalGuide, cardinalguide.com, where you can get contact information for Hans if you've got a situation like this, all there at the website cardinalguide.com. We'll be right back with a whole lot more on filling out these applications, which, by the way, is helpful from my perspective on all sorts of insurance claims, realizing that it helps to know where the I's are supposed to be dotted and the T's are crossed.

We'll be right back. Contact Hans at cardinalguide.com. That's cardinalguide.com. Welcome back to Finishing Well with certified financial planner, Hans Scheil, and today's show is getting the I's dotted and the T's crossed on that application for home health care insurance claim or a long term health care claim. On your board, you separated this out so that people could easily see, you know, what they were going to run up against so that, you know, they'd be able to get it done right. We're just going to look at this definition of care.

That's what we were talking about. And key words in here is substantial assistance. And the key word is substantial, meaning that, you know, like if you took the six ADLs, bathing, continence, dressing, eating, toileting, and transferring, you need substantial assistance with two of those.

And you have to, that's required for you to just make it through the day. And so, key word being substantial, like for the eating, it's just not good enough if somebody prepares your meal for you. I mean, you could make a case that I need substantial assistance with somebody preparing a meal for me.

Yeah, I agree. I mean, you know, where I need assistance anyhow. And substantial assistance with eating really means that somebody is going to feed it to you, okay?

They're going to sit there, at least help you get it on the fork or cut it up or, you know, substantial assistance means substantial assistance. And so, for starters, what I recommend people do when they come to me is it only says you got to meet two of them. And the easiest two to qualify for that everybody needs to do regularly, we'll just say, is bathing and dressing. And so, those are the two that I always focus in on.

And then if we can't meet the standard on those two, then we'll start looking at some of these other. But, you know, when you think about it, a person with bathing, they either need assistance or they don't, okay? I mean, if they can go into the bathroom, turn on the water in the shower, get into the shower, set their towel out to the side, bathe themselves, turn the water off, towel themselves off, go out, and get something wrapped around them, well, then they don't need assistance with bathing. But if they need somebody to turn the water on, help them get in there, watch them while they're in there. So, I mean, I don't want to go into all the length because it's just, it's pretty easy for somebody that's filing a long-term care claim to make the case that they need substantial assistance with bathing. Same thing's true with dressing.

I mean, just dressing is something we all have to do once a day, sometimes more than once a day. And you either need help with that or you don't. And most people that meet this care qualification and they're getting home health care, they need substantial assistance with those two things.

Now, you can go on and see the others, but those are the two that I zero in on, and that's for starters, okay? And when it, when you're trying to qualify somebody for a benefit payment, I mean, if they're checking into an assisted living, it's pretty easy because they're not going to let you into the place unless you need help with two or more of these things. So it's usually on home health care claims, where a lot of claims start, that the question gets brought up and nobody ever reads this thing before they, before they start filing a claim.

Right. And the other thing that was really helpful that Tom brought out was, you know, you can actually help the certified health care assistant, which again, knowing what needs to be on your claim, whether it's a doctor or a certified health care assistant, you can actually walk them through what they need to write down so that it doesn't get confused, right? Well, absolutely, because there's a big or in here. And or means one or the other, because the or is that they require substantial supervision caused by a severe cognitive impairment. So in other words, if you have a cognitive impairment, or your loved one does, and you know, like Alzheimer's, like dementia, like a whole lot of other things they call it, but if they require, and again, substantial supervision, that doesn't mean calling them up every hour. I mean, that means that somebody's there watching them. And they're there for them.

That doesn't mean you're staring at them every hour. And that doesn't mean you couldn't do it for four or five or six people. But if they require substantial supervision caused by severe cognitive impairment, and they meet that criteria, then we don't have to mess with the first step that I was talking about. It's or. It's one or the other. So, and frankly, most people file in long term care claims have some level of dementia.

I mean, they just do. And or memory loss or whatever you want to call it. So you really need to, before you start filing one of these claims, is you need to decide, is this a memory based thing? Or is this a physical thing?

And do they need care with the activities of daily living? And then is it just complicated with dementia? Because if you start trying to prove and going down both roads, it gets a little confusing. And so my recommendation is, is you make a decision whether we're going to do the physical thing with the ADLs or we're going to do the cognitive thing, but we're not going to be stuck in the middle. All right. And unfortunately, doctors get into that sometimes and they want to, you know, make some kind of comment on every paragraph and that just messes up the claim.

Oh, it does. And a lot of times we get brought into these after the claim's already gotten into the home office and the insurance company is already balking or asking for more, or they've been asking for more and they've been writing to the doctor. And the reality is, with most of these policies, you don't even have to get the doctor involved. A licensed healthcare practitioner is all you need. The social worker, it's usually not a nurse, but sometimes the social workers are nurses. It's just that person, if they're a licensed healthcare practitioner, they can fill out and certify the claim. And all they're certifying, they're not giving your whole health history, this person needs help, substantial assistance with bathing and dressing. I mean, literally, if you put all that down and you put nothing more, pretty good chance you're going to get your claim paid.

But so you're right. I mean, we can use the doctor, and a lot of people do, but the doctor is generally going to put down too much or he's going to cover a whole lot of areas with three or four words. And they're going to have to check every sentence.

And then it just invites, they're going to check every last little thing he puts down out. And people are reasonable to get mad about this. But what I'm just telling you, it can be not as frightening as we're talking about, not as bad as what we're talking about. And, you know, I'm more than happy to help anybody with this. I mean, so you just, if you're one of going through this problem, let me know and I'll give you some counseling on how to get this thing paid. If you're a person who's just using a bad experience or just, some people it's good enough for them if they just heard about the bad experience.

You know, from somebody secondhand or thirdhand, that's enough for them to say, I'm never messing with that stuff. And long-term care insurance I'm talking about. And that's really why we did this thing, is we just want to kind of get the ugliness of the claim time out on the table and we just want to talk about it. There are ways to deal with it and these people ultimately get their claim paid.

And so will you. And I'd hate to see you do without long-term care insurance because you're making that decision based on hearsay. Yeah, as I just said, my mother-in-law fell two weeks ago and I'm just sitting there knowing what I know about it.

She unfortunately has nothing to help her except a daughter who's completely overwhelmed with all that's going on and oh my goodness, I do not want to put my kids through or anybody, right? Where they can't get some kind of break, they can't get some kind of help. It gets heavy duty when they're in their 80s because just like you said, Hans, that usually there is some dementia going on with that too and they're not really aware of all that's going on which just makes for bigger messes and oh my goodness, this is such a wonderful, in my opinion, opportunity for you to assess the situation, realize that these claims, you know, they're going to take some effort to get done, everything in life does. And so, but man, it is so worth it because you see this kind of thing all the time.

Well, we do. It's every day and not all clients are like that and the easiest people to deal with for buying long-term care insurance or taking part of their assets or their IRA money and buying a hybrid are people that have had this in their family which is a lot of people. I mean, you have a husband and a wife and they each have two parents, you know, so that's four people and these people that are coming into us are in their 60s or 70s or 50s and they're one of those four people or two of those four people has probably spent some time needing care and the kids had to deal with it and this is usually a pretty easy conversation with those people. Now, the hardest people to deal with are people that are just kind of in the blue where they just, you know, they haven't experienced it so they don't totally know what we're talking about.

They think it won't apply to them or they're well-to-do people that have already made up their mind the way they're going to distance themselves or come up with a easy solution. I'll just pay for it myself out of my money. And so we just got about a minute left, Hans. You know, I think we can make that call once again that if you know somebody that's struggling with that, get up with Hans. I mean, that's why we, cardinalguide.com, we talk about that every week or, you know, at Cardinal Advisors on the YouTube channel, the links are there to get up with Tom or his company and, you know, that's what you guys are there for is to, you know, how God placed you for such a time as this for people that are struggling with this stuff. Yeah, it's just something you need to plan for and we can certainly help you do it. There's lots of ways. We have smaller policies like the one you bought, Robbie, that give you a year in a nursing home or an assisted living and they give you separate benefit a year at home where you have substantial indemnity benefits.

And sure, you could use that up and run out of benefits, but, you know, if your mother-in-law had this policy, I mean, you would have had people in since the day she fell and it would have made your life a lot easier. Oh my goodness. Oh my goodness.

Yes. So, again, Hans Shiel is, you know, Cardinal Advisors is the YouTube channel. It's got a wonderful video on this whole subject, shows you a lot more on this claim process as well as, of course, cardinalguide.com, as we always talk about where you can get Hans's book, The Complete Cardinal Guide to Planning for and Living in Retirement. Thanks again, Hans.

Great show. Thank you. Finishing Well is a general discussion and education of the issues facing retirees. cardinalguide.com, Cardinal Advisors, and Hans Shiel, CFP, sell insurance.

This show does not offer investment products or investment advice. We hope you enjoyed Finishing Well, brought to you by cardinalguide.com. Visit cardinalguide.com for free downloads of this show or previous shows on topics such as social security, Medicare, IRAs, long-term care, life insurance, investments, and taxes, as well as Hans's best-selling book, The Complete Cardinal Guide to Planning for and Living in Retirement and the workbook. Once again, for dozens of free resources, past shows, or to get Hans's book, go to cardinalguide.com. If you have a question, comment, or suggestion for future shows, click on The Finishing Well radio show on the website and send us a word. Once again, that's cardinalguide.com, cardinalguide.com. This is the Truth Network.