Long Term Care Certification Practice Test

Which of the following would likely NOT be a reason for denying a long-term care insurance claim?

1. The insured did not meet the policy's elimination period

2. The services were not pre-authorized

3. The insured met the eligibility criteria for benefits

4. Benefits were sought after the policy lapsed

The correct answer is: The insured met the eligibility criteria for benefits

The correct choice indicates that the insured met the eligibility criteria for benefits, which would not be a reason for denying a long-term care insurance claim. When a claimant meets the eligibility criteria outlined in their policy, they have satisfied the conditions necessary to qualify for benefits. This means the insured has adhered to the policy requirements, making them eligible to receive the necessary support and coverage for their long-term care needs. The purpose of having eligibility criteria is to ensure that only those who adequately fulfill the conditions set forth by the insurer can access the benefits designed to aid them. Other options involve situations that represent deviations from the policy terms, such as not meeting the elimination period, not having services pre-authorized, or seeking benefits after the policy has lapsed, all of which are valid reasons for denial. Therefore, meeting the eligibility criteria signifies compliance with policy requirements and should lead to the approval of the claim, making it the option that would not warrant a denial.