- Thread starter
- #51
ltc, thanks. How does that illustration look at std/nt? I doubt she'll make preferred, but I don't know their uw guidelines.
Life Ins W LTC
- Thread starter pfg1
- Start date
ltc, thanks. How does that illustration look at std/nt? I doubt she'll make preferred, but I don't know their uw guidelines.
Breathing non smokers get "Preferred."
Impaired risk cases get "Preferred" with a table rating or just get declined.
She will get Preferred.
- Thread starter
- #53
Thanks. Wish a few of the carriers I use most would uw like that ... LOL
- 10,806
With many of the LTC Rider on life policies (and annuities), the catch seems to be that they need to be "permanently impaired".
Does anyone have any good statistics on the %s of permanent impairment vs. non?
What % of LTC risk would a permanent requirement rider cover?
Jack? Ed? Arthur? I know one of you must know these numbers... Ive searched on google but have not found anything specific to what Im asking.
Does anyone have any good statistics on the %s of permanent impairment vs. non?
What % of LTC risk would a permanent requirement rider cover?
Jack? Ed? Arthur? I know one of you must know these numbers... Ive searched on google but have not found anything specific to what Im asking.
Well, Restoration of Benefits rider is typically sold for 5% premium, so a 20-1 ratio; but profit is built-in. So, figure true odds are 35-1. To me, the issue is not the likelihood of recovery. The important issue is the legal contract provides an insurance company an opportunity to deny a claim. An insurance claims adjuster may state "we feel your need is not permanent. Claim denied"
And how do you prove your need for care is not permanent? Why would you buy a contract that only pays for a permanent need? As an insured, do you really wish to or need to fight with an insurance company over this. I only want to show I need care. Period. Pay me.
- 10,806
So you are saying based on pricing, there is a 2%-5% chance of using the Restoration of Benefits.
I understand your logic, but that seems like an awfully low number... that would mean 95%-98% of claims are for a permanent impairment... but not really since its also including nursing home care (which accounts for 30% of claims) where a person has a strong likelihood of dying in 1-4 years statistically speaking...
I guess the better question would be how many Home Care & Assisted Living claims are for permanent impairments? (since most nursing home claims seem to be for permanent impairments)
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Im trying to gauge how effective some of the life riders out there actually would be statistically speaking. (and some annuity riders)
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I would have to disagree with your skepticism on this one. If you read the contract language it is no different than proving 2 of 6 ADLs really. A certified doctor must perform an exam and state if they reasonably expect the impairment to be permanent or not. If the carrier disagrees they can ask for a second opinion from a different doctor. If the insured disagrees with the 2nd Doc, they can appeal the decision and usually will see a mutually agreed upon 3rd Doc to break the tie. (Ive seen this done for DI policies multiple times)
In the same way, the carrier could say that they disagree with the doctors decision on 1 of the 2 non-permanent ADLs.
Either way the Doctor is the one "proving" both circumstances. Its not just an arbitrary decision by the carrier.
Remember, the industry in general has plenty of experience judging permanent vs. temporary ADLs from the DI industry.
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Bravo.
Perfectly Stated!
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It is NOT the same thing as ADL's.
The reason ADL's were chosen as benefit triggers two decades ago is because ADL assistance is objective.
There's no "judgment call".
Either the insured can't perform an ADL without assistance, or he can.
There's no "maybe, maybe not" on the part of the doctor or nurse certifying the need.
When you start to talk about what may or may not happen in the future, that is EXTREMELY SUBJECTIVE!
The idea of "permanent disability" is vastly different than the reality of being "disabled right now."
One requires the healthcare practitioner to predict the future.
The other requires a simple analysis of present facts.
Open your eyes.
Don't be deceived.
- 10,806
Im not sure how you think Im being deceived. But I will overlook your condescension for the sake of constructive discussion.
ADLs are not 100% objective. That is why a doctor must certify that they are unable to perform them.
I would agree that permanent impairment is more subjective than non-permanent. But it is hardly as cut and dry as you make it.
I might not have your experience in the LTC field. But I have years of experience in the DI field. DI can deal with ADLs too, and trust me, it is anything but cut and dry. (though DI is more difficult since you have to account for the ability to perform a job as well)
Now with the elderly it is usually an easier call, but it is still subjective to an extent (and the subjectiveness will depend on the specific impairment). To suggest otherwise is disingenuous.
And as I stated before, the DI industry has 50+ years of dealing with ADLs and how permanent an impairment is....
And this has little to do with my original question.
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One thing we are not taking into account with these figures is the amount on non-use of policies. Around 40%ish will never make a claim, and that is figured into the pricing of the Rider as well.
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Your statement is not logical.
Faulty reasoning like this is what leads me to believe you're not thinking very clearly.
A licensed healthcare practitioner's certification of the claimants need for ADL assistance is required for the same reason that a certification of death is required to pay a death benefit: The contract requires it!
Is a certification of death required because death is "not 100% objective"?
:-)
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- 10,806
Death is 100% certain. ADLs can be subjective. That is why insurance companies have appeal processes in place and reserve the right to require a second doctors opinion if they doubt the first one.
Lets say someone falls and hurts their back.... one doctor might think they are unable to bathe and dress themselves... another doctor might not agree. Usually that will not happen, but it can.
And none of that changes the fact that insurers have a process in place to determine permanent impairment (just like in the DI world).
Out of curiosity, do you have any stats or info about my original question?
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