Starting a Long-Term Care Insurance Claim: A Document Checklist

Starting a long-term-care insurance claim is easier when the family separates three questions:

1. 1. What does the policy require?
2. 2. What facts show the insured meets the benefit trigger?
3. 3. What documents prove covered services were actually received?

Do not send a random pile of medical records. Build a claim file around the insurer’s instructions and the policy language.

Start with the policy itself

Find:

• policy number;
• declarations/schedule of benefits;
• riders;
• elimination period;
• benefit triggers;
• covered settings/services;
• daily/monthly maximum;
• lifetime/pool maximum;
• inflation provisions; and
• claims contact information.

If the policy cannot be found, contact the insurer or agent using verified contact information.

Request the insurer’s claim packet

Ask:

• Which claim form?
• Who completes the care assessment?
• Does the attending clinician need to certify anything?
• Are facility licenses/certifications required?
• Are invoices needed monthly?
• Does the insurer require authorization to obtain records?
• Is there a deadline for submitting proof?

Do not assume another insurer’s form will work.

Gather current care evidence

Depending on the policy, the insurer may need documentation about:

• activities of daily living;
• cognitive impairment;
• plan of care;
• diagnoses;
• current services;
• facility or home-care provider; and
• dates care began.

Describe what the person actually needs. Do not exaggerate or minimize.

Verify the provider qualifies under the policy

A policy may define eligible nursing homes, assisted-living facilities, home-care agencies, or caregivers.

Ask the insurer to confirm whether the current provider meets the policy definition.

Do not rely solely on the provider saying “we take LTC insurance.”

Track the elimination period

If the policy has a waiting/elimination period, ask:

• when it starts;
• whether it counts calendar days or service days;
• what care days count;
• what evidence is needed; and
• when benefits become payable.

Keep a dated service log.

Claim-file checklist

• [ ] Full policy/riders
• [ ] Claim form
• [ ] Benefit schedule
• [ ] Clinical/care assessment
• [ ] Provider qualification evidence
• [ ] Plan of care
• [ ] Invoices/service logs
• [ ] Authorization forms
• [ ] Elimination-period record
• [ ] Claim number
• [ ] Submission confirmation
• [ ] Follow-up date

Keep originals and submission proof

Save copies of everything sent.

Record the portal confirmation, fax receipt, certified-mail tracking, or other submission evidence.

Frequently asked questions

Should we submit every medical record?

Only what the insurer requests or what is relevant to the claim. Ask before sending unnecessary sensitive records.

Can a facility file the claim for us?

Some help with paperwork, but the policyholder/representative should still understand what is submitted and keep copies.

Does completing the packet mean benefits are approved?

No. The insurer still evaluates eligibility under the policy.

The practical goal

A clean claim file should let someone answer:

Which policy provision is being claimed, what facts trigger it, which provider/services qualify, and what evidence was submitted?

Related NHP guides

• Will Long-Term Care Insurance Pay for Assisted Living or a Nursing Home?
• Long-Term Care Insurance Elimination Period

Primary sources checked

• NAIC — A Shopper’s Guide to Long-Term Care Insurance
• NAIC — Publications / state insurance department contacts

*Editorial/source review: October 15, 2026. General education only. Insurance contracts, tax consequences, Medicaid, family loans/gifts, and legal authority require case-specific verification.*