AD Banker Comprehensive Practice Exam

What is a common reason insurers might deny a claim for a Long-Term Care Policy?

1. Failure to submit the claim within 30 days

2. Policyholder's failure to pay premiums

3. Care received from an unapproved facility

4. Condition unrelated to the claim stated

The correct answer is: Care received from an unapproved facility

A common reason insurers might deny a claim for a Long-Term Care Policy is when the care has been provided in an unapproved facility. Long-Term Care policies typically have specific requirements regarding the types of facilities that are eligible for coverage, which can include licensed nursing homes or certain approved assisted living facilities. If care is received at a facility that does not meet the insurer's criteria, the claim may be denied. This underscores the importance of policyholders understanding the terms of their coverage, including the types of care providers that are acceptable under their policy. Other reasons for denial may involve situations where claims are not submitted promptly, premiums are unpaid, or conditions experienced are unrelated to what the policy covers, but such situations depend on different factors that may not directly relate to the care provider's approval status.