Documents Required for a Long-Term Care Insurance Claim

Long-term care insurance carriers may require several forms and supporting documents when an initial claim is opened. The exact requirements vary by insurer, policy, type of care, and the person submitting the claim.

Your insurance carrier’s current claim packet should always be your primary checklist. This guide explains the documents commonly requested and what each one is generally used for.

Documents Your Long-Term Care Insurer May Request

1. Claimant Statement or Claim Form: Most claims begin with a carrier-specific form completed by the policyholder or an authorized representative. This typically provides basic information about the insured, the type of care being received, and the claim being opened. Always use the current form supplied by your insurer.

2.Health Care Provider Statement or Certification: Your carrier may request information from a physician or another qualified health care professional regarding your health, functional limitations, cognitive impairment, or need for long-term care. The exact form and acceptable professional vary by insurer and policy.

3. Authorization to Obtain Health Information: The insurer may ask the policyholder or legal representative to sign an authorization allowing the carrier to obtain relevant medical or health information needed to evaluate the claim.

4. Care Provider or Facility Information :Depending on the policy and type of care, the insurer may request information about the home-care provider, assisted-living community, nursing facility, or other care provider. The carrier may also need information showing that the provider satisfies the policy’s requirements.

5. Plan of Care or Functional Assessment: Some claims may require a plan of care, functional assessment, cognitive assessment, or other evaluation documenting the type and level of assistance the insured needs. Follow the specific instructions in your carrier’s claim packet

6. Legal Representative Documentation, When Applicable: If someone other than the policyholder is acting under legal authority, the carrier may request a Power of Attorney, guardianship documentation, or another applicable authorization. A carrier may also have its own third-party authorization form for communicating with another person or organization.

Additional Documents Your Carrier May Request

• Depending on your claim and type of care, additional documentation may include:
  • Medical records or discharge information
  • Functional or cognitive assessments
  • Care-provider information
  • Facility admission documents
  • Invoices, receipts, or records of services provided
  Do not assume every item is required. Submit what your carrier requests for your particular claim and keep copies for your records.

How to Organize Your LTC Claim Documents

Create one dedicated physical or digital folder for your long-term care insurance claim. Keep copies of forms and documents you submit, along with the date and method of submission and any confirmation number or receipt provided by the carrier.
Also keep your claim number and carrier contact information in an easy-to-find location.

Helpful Tip

Ask your insurance carrier for its current claim packet and documentation checklist before submitting your initial claim. Requirements can differ significantly between carriers and policies.

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