LLQP Accident & Sickness · Component 4.2 · 10% of the exam
A long-term care claim requires the claimant to establish that:
- AHe has exhausted the provincial home care programme's available hours for the year
- BHe is unable to perform the duties of the occupation he held before the care became necessary
- CHe has been admitted to hospital for a continuous period of at least thirty days
- He cannot perform the required number of activities of daily living, or is cognitively impaired
Correct answer: D) He cannot perform the required number of activities of daily living, or is cognitively impaired
Long-term care contracts turn on function and cognition, certified by an assessment, and reimbursement designs add proof of the care actually received.
Why the other options are wrong
- APrivate benefits do not wait for a public programme to be exhausted.
- BOccupational tests belong to disability insurance.
- CHospital confinement is not a long-term care trigger.
Exam tip
Function and cognition, not occupation.
Common mistake
Applying disability concepts to a long-term care claim.
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.