Underwriting & Claims Flashcards
What is the underwriting process for pre-funded LTCI?
Underwriting for pre-funded LTCI ensures applicants disclose any conditions that might increase the risk of a claim, using tools like proposal forms, private medical attendant’s reports, and medical examinations.
How are claims assessed for LTCI policies?
Claims are assessed using criteria such as Activities of Daily Living (ADLs) and cognitive tests to determine the level of care required. Insurers may also implement deferred periods and checks to prevent fraudulent claims.
What are common exclusions in LTCI policies?
Common exclusions include self-inflicted injuries, care received outside the UK, and non-organic mental disorders. Claims may also be restricted by deferred periods and ongoing eligibility checks.
What is the reverse underwriting process in immediate needs LTCI?
The reverse underwriting process in immediate needs LTCI ensures applicants do not over-disclose their medical conditions, assessing the risk to provide appropriate coverage.
What are Activities of Daily Living (ADLs), and why are they important in LTCI claims?
ADLs are basic self-care tasks such as bathing, dressing, and eating. They are used to determine the level of care required for LTCI claims, helping insurers assess eligibility and the extent of benefits needed.
