What does the claims process look like?
Generally, once the insured has suffered the loss of two activities of daily living or is diagnosed with a severe cognitive impairment, the insured, their doctor and family and the insurance company enter into the case management, assessment and plan of care process. The insurance company either contracts with or employs case management professionals that assist the insured and their family in determining the care needs of the insured. This assessment process looks at the functional incapacity of the insured and from this a plan of care is created. This plan of care, or prescription for care, outlines the insured’s needs. The insurance company will base its claims payment on this plan of care and will periodically request that a new assessment be performed in order to assure that the insured is receiving the levels of care that they require.
