Transferring and Your Long Term Care Insurance Benefits

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Transferring is one of the activities of daily living (ADLs) that individuals need to be able to do in order to care for themselves independently. Sometimes called ambulating, transferring refers to the ability to walk or move from a bed, chair or wheelchair and back again. Impairment of transferring is typically one of the ADLs used to determine whether individuals covered by long term care insurance policies are eligible for benefits. Long term care benefits can cover the cost of care, such as a home health care attendant to provide regular assistance, when a chronic, disabling condition causes an inability to move around independently.

When making a claim for long term care insurance benefits, insurance companies often manipulate facts and rely on vague policy language to try to dispute, deny or terminate long term care benefits. If you or a loved one is struggling with transferring, here is what you can do to ensure you get your benefits. 

Transferring is key to independent living

As we age, musculoskeletal, neurological, circulatory, sensory or other conditions may result in a decline in physical function. This can lead to the inability to transfer, along with the inability to perform other ADLs, including eating, dressing, bathing, toileting and continence.

Those who cannot independently walk or move themselves from their bed to a chair or wheelchair and back need regular assistance. Wheelchair users typically perform eight or more transfers per day. As strength and mobility decline, repeated transfers can lead to overuse injuries in wheelchair users. Further, those who struggle with transferring will also have difficulty with other ADLs. Bathing, for instance, requires that an individual transfer in and out of a bathtub or shower. 

Check your policy and collect documentation

If you are considering making a claim for yourself (or a loved one), the first step is to check the policy closely to see how transferring or ambulating is defined. Next, you will need to document and prove a lack of ability to get around independently. If you are the claimant, you should provide your own written statement about your daily habits and the challenges you face, as well as a statement from your spouse, a family member or a close friend about their observations or experiences with your need for transferring assistance.

You will also need to get an ADL assessment, which is typically performed by a registered nurse, who can come to your home and observe and document the limitations on your ability to transfer and your inability to perform other ADLs. Your doctor can use the assessment to create an appropriate plan of care, and both the ADL assessment and the doctor’s statement will document your entitlement to benefits. 

Prepare for your evaluation

Your long term care insurance company will most likely send its own nurse to your home to evaluate whether you are entitled to benefits. Prior to the visit, read and understand your rights and obligations under your policy. It’s imperative that you as the claimant not meet with the nurse alone. Seniors and other claimants sometimes underreport the difficulties they are experiencing out of embarrassment, nervousness or forgetfulness. Having a trusted companion or professional representative present during the evaluation helps ensure an accurate picture is given.

In addition, that person should take detailed notes about all the questions asked by the nurse along with the responses given by the claimant. It’s always better to have a trained advocate prepare you for the in-home evaluation and protect your rights throughout the visit. 

If you are considering filing a long term care insurance claim, or if your claim is being challenged or has been denied, give us a call. We have the experience, knowledge and tenacity to make the insurance company keep the promises it made to you or your loved ones.

Evan-Schwartz

Evan S. Schwartz
Founder of Schwartz, Conroy & Hack
800-745-1755
ESS@schlawpc.com

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