Why don't the majority of providers make it clear in the pre-sale documentation, the level of assistance required by ADLs in regards to support from others?
The simple answer is because most of the major providers assess the failure of an activity of daily living (ADL) without the assistance of another person. It really does not matter whether somebody else is available or not.
For example, our policy conditions say: 'We will pay long term care (LTC) benefit if, for a continuous period of three months, you have been unable to undertake the number of activities of daily living shown in the schedule, when using appropriate special equipment devices or modified clothing. As a result you need the assistance of another person on most occasions that you try to undertake them.'
This question does, however, illustrate the importance to the adviser of being aware of the exact claim criteria.
It shows how regularly the activity of daily living needs to be failed. Better policies will include the 'on most occasions' definition, rather than stipulating 'on every occasion.'
Also check whether the benefits are payable in full and tax free to the client, or only up to the amount and paid to care providers. Naturally most claimants would prefer the cash.
Brian Fisher
