Claims are where "the rubber meets the road," and the reason why anyone purchases insurance in the first place. Since an insurance contract is fundamentally a promise-- one which may not be fulfilled for ten, twenty or thirty years-- it's reasonable to assess the track record of the company come claim time. The LTC industry currently supports about 350,000 active claimants by paying out over $36 million each day, and is expected to pay out nearly $800 billion for all existing policyholders over their lifetimes.

A number of studies have looked at claims, from the carriers themselves to the Society of Actuaries (SOA) to the Department of Health and Human Services. As reported by AHIP (2014), the government study found, "in the great majority of cases, claims are settled to the satisfaction of claimants— policyholders do not feel that they have to “fight for” benefits, and they report that disagreements are resolved fairly."

But the most detailed and robust research ever conducted on long-term care insurance claimants was published September, 2016. Called “Experience and Satisfaction Levels of Long-Term Care Insurance Customers: A Study of Long-Term Care Insurance Claimants,” (Marc Cohen, PhD, LifePlans) it examined claimants' experiences with the filing process and their satisfaction with how their policies performed. The highlights are immensely reassuring:

  • Nearly 90 percent of those with long-term care insurance are satisfied with the amount of coverage they purchased.
  • Almost eight in 10 customers found filing a claim to be easy.
  • 89 percent of consumers reported that they did not need to purchase any additional services not covered by their policy.
  • The number of individuals filling new claims exceeds 70,000 a year
  • About 97 percent of claimants are satisfied with their policy (and 70 percent are “very” satisfied)
  • Only 2 out of 100 people making claims under their LTC policy are likely to have a disagreement that’s not resolved to their satisfaction
  • Nearly 9 in 10 claimants had no trouble understanding what their policies cover
  • About 3 in 4 claimants said, if they didn’t have insurance, they would receive less care
  • About 2 in 3 claimants said, if they didn’t have insurance, they’d have to rely on family & friends
  • About 3 in 4 claimants believed their insurance enabled them to access higher-quality care
  • Nearly 2 in 3 said their benefits covered all or most of their costs, in line with their expectations at purchase

For those who wish to review the claimant satisfaction survey in greater detail, you'll find LTCA's summary in our Blog, along with selected charts we think you'll appreciate.