Why back-dated 'claim effective date'

[JCS-twelve]

Purchased a policy in 1995 for my mom from a well known provider and I have kept it current for the last 27 years. The policy was inflation adjusted with a 3 year benefit period. My mom entered assisted living on 3/1/2022 and I filed the initial claim on 3/2/2022. The claim was approved but the 'claim effective date' was back-dated to 2/1/2021.

I've asked why and the vague response has been 'internal clinical documentation from the initial evaluation'. I've asked to have the claim effective date adjusted to 3/2/2022, but they have refused.

I have concerns that the benefit window will expire a year before the maximum benefit payout is achieved. Some online information says that the benefit window is not a finite amount of time - the maximum benefit amount is what's key. That said, I feel not having the effective claim date adjusted to reflect the actual date when the claim was filed leaves me potentially at risk.

looking for guidance on next steps.

 

[ltcadviser]

Purchased a policy in 1995 for my mom from a well known provider and I have kept it current for the last 27 years. The policy was inflation adjusted with a 3 year benefit period. My mom entered assisted living on 3/1/2022 and I filed the initial claim on 3/2/2022. The claim was approved but the 'claim effective date' was back-dated to 2/1/2021.

I've asked why and the vague response has been 'internal clinical documentation from the initial evaluation'. I've asked to have the claim effective date adjusted to 3/2/2022, but they have refused.

I have concerns that the benefit window will expire a year before the maximum benefit payout is achieved. Some online information says that the benefit window is not a finite amount of time - the maximum benefit amount is what's key. That said, I feel not having the effective claim date adjusted to reflect the actual date when the claim was filed leaves me potentially at risk.

looking for guidance on next steps.

There are not any time limits on your mom’s policy. Her benefits are not adversely impacted. Her benefits are based on her pool of money. Her policy will last until she has exhausted her total amount of money. You are not at risk whatsoever and you can relax. The underwriter properly backdated the effective date to the documented date of the beginning of satisfying the definition of chronically ill. This actually protects policyholders that might possibly have accumulated receipts earlier; allows elimination periods to possibly be satisfied earlier, etc.

 

[JCS-twelve]

That's great news. Appreciate the quick reply.

I wish they would have provided this information in the policy documentation, but then again the policy documentation is 27 years old. It's also not addressed on their website LTC Claim FAQs either. And finally, two levels of off shore care center escalations could not effectively communicate the why.

Again, thanks!