LLQP Accident & Sickness · Component 4.2 · 10% of the exam
A client whose father can no longer bathe or dress himself asks how to claim on his long-term care policy. The claim requires:
- Certification of ADL loss or cognitive impairment, a plan of care, and receipts under a reimbursement policy
- BA hospital stay of at least seven days, which the insurer treats as evidence that ongoing care is needed
- CAn employer's statement confirming the claimant can no longer work because of the need for care
- DProof of age only, since long-term care benefits become payable once the insured reaches the stated age
Correct answer: A) Certification of ADL loss or cognitive impairment, a plan of care, and receipts under a reimbursement policy
LTC claims are function-based. Reimbursement contracts add provider and receipt requirements.
Why the other options are wrong
- BHospitalization is not required.
- CEmployment is irrelevant.
- DAge is not the trigger.
Exam tip
LTC claim: ADL/cognitive certification, care plan, receipts if reimbursement.
Common mistake
Assuming any home-care arrangement qualifies under a reimbursement policy.
What this tests
CISRO competency component 4.2 — Provide customer service during the validity period of the coverage — which is weighted at 10% of the Accident & Sickness module. Written against the published curriculum.
More from component 4
- The agent's role in the claims process is to:
- A client with a non-cancellable DI policy stops paying premiums after a dispute with the insurer about a claim. The agent should warn that:
- When a client moves to another province, the agent should:
- A client asks to reduce the waiting period on his in-force disability policy. The agent should explain that the change:
- A client's disability policy lapsed six weeks ago for non-payment. The agent should:
- A client on claim asks whether she must keep paying premiums. The accurate answer depends on:
Practice the whole Accident & Sickness module
Timed sets weighted like the exam, and review of every question you miss. Free to start.