Part of our guide: Long-Term Care Insurance: Costs, Options and Planning →
Most long-term care policies you sell today won’t have a claim for years. But when a client or their family calls because care is needed, knowing exactly how the claims process works lets you guide them through one of the hardest moments they’ll face.
Key takeaways
- Benefits are usually triggered when a licensed health practitioner certifies the insured needs help with two of six activities of daily living for at least 90 days, or has a severe cognitive impairment.
- Notify the carrier promptly, usually within 30 days of the need for care or as soon as reasonably possible.
- After eligibility is confirmed and the elimination period is met, benefits are paid to the insured or the provider.
Many families wait until the family caregiver is exhausted to file. Encourage them to call as soon as care is needed.
When families usually file
People don’t like admitting they need help, so families often provide care themselves at first. Claims tend to be filed when the family caregiver burns out or the care needed exceeds what they can provide. Earlier filing can mean benefits start sooner, since the elimination period can begin counting.
Step 1: Confirm benefit eligibility
For tax-qualified policies, a licensed health care practitioner must certify that the insured is chronically ill: unable to perform at least two of six activities of daily living (bathing, dressing, eating, toileting, transferring, continence) for an expected 90 days or more, or needing substantial supervision because of severe cognitive impairment.
Step 2: Notify the insurance company
Notice is usually due within 30 days of the onset of care needs, or as soon as reasonably possible. It can often be given by phone or mail and should include the insured’s name and policy number.
Step 3: Claim form and assessment
The carrier sends a claim form, which is returned with provider bills or other proof of loss. The carrier then verifies eligibility, often through an in-person assessment or by contacting the insured’s health care practitioner.
Step 4: Care planning and payment
Once the claim is approved, a care coordinator or case manager often works with the family on the right type of care. After the elimination period is satisfied, benefits are paid to the insured or directly to the care provider, depending on the policy. See how cash benefits differ from reimbursement.
Frequently asked questions
What triggers long-term care insurance benefits?
Typically, being unable to perform two of six activities of daily living for at least 90 days, or having a severe cognitive impairment, as certified by a licensed health practitioner.
How soon should a long-term care claim be filed?
Usually within 30 days of the need for care, or as soon as reasonably possible. Filing early can help the elimination period start sooner.
What is the elimination period in LTC insurance?
A waiting period, often 30 to 90 days of qualifying care, before the policy begins paying benefits.
Reviewed by Tim Fuller on 2026-09-25
Tim Fuller
President, SRS Inc.
Tim leads SRS Inc., a full-service IMO (Independent Marketing Organization) and BGA (Brokerage General Agency), connecting independent financial professionals with life, annuity, disability income, and long-term care solutions from 60+ carrier partners.
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