National Long-Term Care Insurance Claims Decision Study: An Empirical Analysis of the Appropriateness of Claims Adjudication Decisions and Payments

Much of the information behind the charges of critics is anecdotal and based on a relatively small number of individuals concentrated in two companies who may indeed have had legitimate grievances based on their personal experience. Yet, this information alone should not allow one to draw broad conclusions about private industry performance in general. Clearly, empirical data on an industry-wide basis is needed to definitively validate or dispense with these charges. The purpose of this project is to conduct a thorough scientific review of an industry-wide sample of private LTCI claims decision made in 2007 and 2008 in order to determine and quantify the extent to which those decisions were appropriate. More specifically, the authors focused on answering two broad questions: (1) Is the denial of benefits to policyholders making claims on their policy appropriate? and; (2) Is the approval of benefits to policyholders making claims on their policy appropriate? [20 PDF pages]