When is a long-term care (LTC) insurance claim typically triggered?

The correct answer relates to the specific conditions under which long-term care (LTC) insurance policies begin to pay benefits. A long-term care insurance claim is typically triggered when a person is unable to perform two out of the six Activities of Daily Living (ADLs). These ADLs include bathing, dressing, eating, toileting, transferring (moving from one position to another), and continence.

Insurance companies define these criteria to assess the level of care an individual may require. When an individual cannot perform a specified number of ADLs, it indicates that they may need assistance with daily tasks, thereby qualifying them for benefits under their LTC insurance policy. This focus on functional abilities helps ensure that the insurance is utilized for its intended purpose—providing support for individuals who genuinely need comprehensive care.

Other possible conditions, such as reaching a certain age or being diagnosed with a chronic illness, do not inherently trigger a claim in LTC insurance. While age may influence the likelihood of needing care, it’s the inability to perform ADLs that explicitly activates the benefits. Additionally, reaching a threshold of medical expenses is typically more relevant to health insurance or critical illness plans than it is to long-term care policies.