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LTC Mind Control

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2011 ICA Annual Education Conference

2011 ICA Annual Education Conference

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  • 1. Judy Bass, State Farm Mutual Automobile Insurance Company Lori Watson, Genworth Financial Watson Rob Pohls, Pohls & AssociatesInternational Claim Association – 2011 Annual Education Conference – Las Vegas, Nevada – October 3, 2011
  • 2. LTC MIND CONTROL Goals: ·E l Explore what makes a good LTC claim h dl h t k d l i handler. · Examine the unique relationship between claimant and claim h dl d l i handler. · Identify approaches to avoiding pitfalls when claim handling h dli errors occur. Process: · Discuss hypothetical scenarios. · Questions. Slide 2International Claim Association – 2011 Annual Education Conference – Las Vegas, Nevada – October 3, 2011
  • 3. LTC MIND CONTROL Scenario #1: The Advice-Seeker · 72 y.o. widow with Parkinson’s id ith P ki ’ and recent shoulder injury · Lives alone in home; Needs help with 3 ADL’s; Receives home care 6 hours/day and 7 days/week · Weekly conversations with examiner, often unrelated to LTC · Insured asks for advice about selecting her POA and whether to apply for Medicare Slide 3International Claim Association – 2011 Annual Education Conference – Las Vegas, Nevada – October 3, 2011
  • 4. LTC MIND CONTROL Scenario #2: The New Glasses · 80 y.o. widow f t id fractures hi and hip d shoulder; Also diagnosed with osteoporosis, diabetes and CHF · Lives alone; Receives daily home care · Claim initially reviewed in detail; less attention paid once payments became routine; On claim for 3 yrs. · New examiner reviews closely; Finds insured only needs help with dressing, dressing meal prep and cleaning Slide 4International Claim Association – 2011 Annual Education Conference – Las Vegas, Nevada – October 3, 2011
  • 5. LTC MIND CONTROL Scenario #3: All in The Family · 60 y.o. f female with d l ith dementia, l ti long history of depression, narcotic and alcohol dependency, short term memory loss; family history of Alzheimer’s · Onsite assessment reveals totally dependent in all IADLs; MMSE is 15/30; Rx = Paxil and Wellbutrin · All care provided by live-in; POC calls for 24/7 oversight and ADL assistance · Highly emotional claim; Conflicting information and desires from family Slide 5International Claim Association – 2011 Annual Education Conference – Las Vegas, Nevada – October 3, 2011
  • 6. LTC MIND CONTROL Scenario #4: Driving Miss Daisy · 58 y.o. f female with b l ith breast cancer t and mets to liver; grim prognosis · Insured is having difficulty with diagnosis and prognosis · Onsite assessment, med records and APS show independent with ADLs and no cognitive deficits · No care in place but would like assistance with IADLs, transportation to and from doctors, treatment, etc. treatment etc Slide 6International Claim Association – 2011 Annual Education Conference – Las Vegas, Nevada – October 3, 2011
  • 7. •No care yet in place but would like assistance with IADLs, transportation to and from doctors, treatment, etc… LTC MIND CONTROL Scenario #5: The Hired Help · 80 y.o. f female with fi d i l ith fixed income finds premium notice after husband passes; calls with Q’s re LTC policy · Examiner explains eligibility criteria (insured denies CI and need for ADL assistance); Also explains nursing home only (with home care rider) · 6 months later, insured calls again to say she has hired a housekeeper who helps with meals, chores, transportation, etc. Slide 7 International Claim Association – 2011 Annual Education Conference – Las Vegas, Nevada – October 3, 2011
  • 8. LTC MIND CONTROL Scenario #6: For Better or For Worse · 83 y.o. f female with shoulder i j l ith h ld injury and d 85 y.o. male with cardiac problems live independently their home; When male’s condition deteriorates, they consider moving into an ALF · Male calls to ask if an ALF would be covered by his policy; Examiner says benefits available if male is benefit eligible and ALF meets definition of NH · After selling their home, couple moves into ALF; Male is covered (b/c needs ADL assistance); Female is not covered Slide 8International Claim Association – 2011 Annual Education Conference – Las Vegas, Nevada – October 3, 2011
  • 9. LTC MIND CONTROL Judy Bass, State Farm Mutual Automobile Insurance Company Lori Watson, Genworth Financial Watson Rob Pohls, Pohls & AssociatesInternational Claim Association – 2011 Annual Education Conference – Las Vegas, Nevada – October 3, 2011