Judy Bass, State Farm Mutual Automobile Insurance Company

Lori Watson Genworth FinancialLori Watson, Genworth Financial

Rob Pohls, Pohls & AssociatesInternational Claim Association – 2011 Annual Education Conference – Las Vegas, Nevada – October 3, 2011

LTC MIND CONTROL

Goals:

E l h t k d LTC l i h dl· Explore what makes a good LTC claim handler.

· Examine the unique relationship between claimant d l i h dland claim handler.

· Identify approaches to avoiding pitfalls when claim h dlihandling errors occur.

Process:

· Discuss hypothetical scenarios.

· Questions.

International Claim Association – 2011 Annual Education Conference – Las Vegas, Nevada – October 3, 2011

Questions.Slide 2

LTC MIND CONTROL

Scenario #1: The Advice-Seeker72 id ith P ki ’· 72 y.o. widow with Parkinson’s and recent shoulder injury

· Lives alone in home; Needs help· Lives alone in home; Needs help with 3 ADL’s; Receives home care 6 hours/day and 7 days/week

· Weekly conversations with examiner, often unrelated to LTC

· Insured asks for advice about selecting her POA and whether to apply for Medicare

International Claim Association – 2011 Annual Education Conference – Las Vegas, Nevada – October 3, 2011

Slide 3

LTC MIND CONTROL

Scenario #2: The New Glasses80 id f t hi d· 80 y.o. widow fractures hip andshoulder; Also diagnosed with osteoporosis, diabetes and CHF

· Lives alone; Receives daily home care

· Claim initially reviewed in detail; less attention paid once payments became routine; On claim for 3 yrs.

· New examiner reviews closely; Finds insured only needs help with dressing meal prep and cleaning

International Claim Association – 2011 Annual Education Conference – Las Vegas, Nevada – October 3, 2011

Slide 4

dressing, meal prep and cleaning

LTC MIND CONTROL

Scenario #3: All in The Family60 f l ith d ti l· 60 y.o. female with dementia, long history of depression, narcotic and alcohol dependency, short term memory loss; family history of Alzheimer’s

· Onsite assessment reveals totally dependent in all IADLs; MMSE is 15/30;dependent in all IADLs; MMSE is 15/30; Rx = Paxil and Wellbutrin

· All care provided by live-in; POC calls for 24/7 oversight and ADL assistance

· Highly emotional claim; Conflicting information and desires from family

International Claim Association – 2011 Annual Education Conference – Las Vegas, Nevada – October 3, 2011

Slide 5

information and desires from family

LTC MIND CONTROL

Scenario #4: Driving Miss Daisy58 f l ith b t· 58 y.o. female with breast cancer and mets to liver; grim prognosis

· Insured is having difficulty with Insured is having difficulty with diagnosis and prognosis

· Onsite assessment, med records and APS show independent with ADLs and no cognitive deficits

· No care in place but would No care in place but would like assistance with IADLs, transportation to and from doctors, treatment etc

International Claim Association – 2011 Annual Education Conference – Las Vegas, Nevada – October 3, 2011

Slide 6

treatment, etc.

LTC MIND CONTROL•No care yet in place but would like assistance with IADLs, transportation to and from doctors, treatment, etc…

Scenario #5: The Hired Help80 f l ith fi d i· 80 y.o. female with fixed income finds premium notice after husband passes; calls with Q’s re LTC policy

· Examiner explains eligibility criteria (insured denies CI and need for ADL assistance); Also explains nursingassistance); Also explains nursing home only (with home care rider)

· 6 months later, insured calls again to say she has hired a housekeeper who helps with meals, chores, transportation, etc.

International Claim Association – 2011 Annual Education Conference – Las Vegas, Nevada – October 3, 2011

Slide 7

LTC MIND CONTROL

Scenario #6: For Better or For Worse83 f l ith h ld i j d· 83 y.o. female with shoulder injury and 85 y.o. male with cardiac problems liveindependently their home; When male’s condition deteriorates, they consider moving into an ALF

· Male calls to ask if an ALF would be Male calls to ask if an ALF would be covered by his policy; Examiner says benefits available if male is benefit eligible and ALF meets definition of NHeligible and ALF meets definition of NH

· After selling their home, couple moves into ALF; Male is covered (b/c needs

International Claim Association – 2011 Annual Education Conference – Las Vegas, Nevada – October 3, 2011

Slide 8ADL assistance); Female is not covered

LTC MIND CONTROL

Judy Bass, State Farm Mutual Automobile Insurance Company

Lori Watson Genworth FinancialLori Watson, Genworth Financial

Rob Pohls, Pohls & AssociatesInternational Claim Association – 2011 Annual Education Conference – Las Vegas, Nevada – October 3, 2011