Some Applications, Claims Denied

Forte said that the approval rate for “underwritten” applications is 85 percent, which he said is in line with industry averages. During the 2002 open enrollment period, active employees and their spouses were subject only to abbreviated underwriting, which asks a limited number of questions. That form of underwriting applies now only to newly hired employees and their spouses; all others are subject to “full” underwriting, which asks a more extensive set of questions. Forte said that the program has received about 500 claims, although about 12 percent of those have been denied. Of the denied claims, about half were the result of misunderstanding by the claimant of what LTC insurance covers, he said. For example, some enrollees apply for benefits on being diagnosed with a serious condition such as cancer even though they do not yet need assistance with activities of daily living. So far no one has used the outside appeals process available when claims are denied, he said.