The Independent In-Person Assessment Process

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This policy brief provides information on the benefit eligibility assessment process in the private long-term care insurance industry. It focuses on how long-term care insurers use the information in the adjudication process, who is involved in the process, and how activities of daily living and cognition are assessed.

Date Updated: 04/06/2011

LifePlans interviewed and surveyed managers involved in the claims adjudication process from the majority of long-term care (LTC) insurance carriers selling policies in the market. We asked a series of questions related to the role of the in-person benefit assessment within the claim adjudication process and how individual activities of daily living (ADLs) and cognitive status are measured. We did this by examining a sample of commonly used benefit determination assessment instruments used by carriers…


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