What Happens When an LTCi Claim Gets Complicated? A Specialist Shares Her Story

Nancy Dykeman, CLTC®, CSA — a long-term care planning consultant with over 20 years of experience — found out firsthand. When her husband suffered two cardiac arrests and required 24/7 home care almost overnight, Nancy had to navigate the LTCi claims process while simultaneously managing his care. What she experienced surprised even her.

The Claims Process Is More Complex Than Most Clients Expect

Nancy’s husband was clearly benefit-eligible. Every health professional agreed. And yet — benefit payments didn’t start for nine months. Misinformation from third-party claims representatives, confusion over elimination period rules, and mountains of documentation created a process that was, in her words, “overwhelming and took a toll on my own health.”

This is not an isolated story. As Linda Jahnke, BCPA, a long-term care insurance specialist turned claims advocate, explains in the same issue: many LTCi claims are delayed or denied not because coverage doesn’t exist — but because of consumer miscommunication, documentation errors, and care provider mistakes.

Where Claims Most Commonly Break Down

For advisors and agents working with LTCi clients, understanding the claims friction points is essential:

• The first phone call matters more than clients realize — how a claimant describes their care needs on that initial call can determine whether the claim moves forward
• Most carriers use third-party administrators, not their own staff — clients are often surprised to learn their carrier isn’t who they’re actually speaking with
• Cognitive impairment claims are especially tricky — policy language using words like “severe” often doesn’t match the clinical language physicians use
• Independent caregivers are a common source of benefit delays — missing care logs and payment documentation can stall or deny claims entirely
• Online portals are now required by some carriers — a barrier for older clients without tech support

What Advisors Can Do Now

Building relationships with patient advocates, elder law attorneys, and geriatric care managers in your area is one of the most valuable things a CLTC® specialist can do for clients before a claim ever happens. Nancy learned this firsthand — and it’s advice every advisor should take seriously.

Helping clients understand the claims process before they need it — the elimination period, documentation requirements, and what third-party administrators actually do — is part of delivering on the promise your clients bought.