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MAKING A CLAIM
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Typically, benefits are payable when you can no longer perform a number of
essential activities of daily living without substantial assistance.
Most plans stipulate that at least two (or more depending on the plan) of the
following cannot be performed without substantial help:
When will benefits be paid?
• bathing
• dressing
• toileting
• transferring (e.g., moving from a chair or out of bed)
• maintaining continence
• eating
Your ability to perform these activities of daily living would be assessed by
representatives of the insurance company to determine your eligibility for benefits.
For example, health care experts such as Occupational Therapists or Nurses may
call you to ask questions, or they may ask to visit you at home. These evaluations
help the claims assessors evaluate your eligibility for benefits. You may also qualify
for benefits if you require substantial supervision because of cognitive impairment
due to conditions that cause dementia such as Alzheimer's.
Terms for approval of benefits can vary from policy to policy.
