Can you lie on an application for Long-Term Care Insurance and get away with it?
On the initial application itself, sure, you could lie and it won’t immediately be caught. However, over the entire process, the application and underwriting process will uncover the truth, and you’ll also be putting yourself at risk in other ways, such as legal or financial.
To explain why this is, it helps to know a little about how Long-Term Care Insurance works, and why using factual medical information is always going to be the correct thing to do.
So the more important question is: Why does accurate medical information benefit the application process, and what are the risks of lying?
That’s what we’ve helped thousands of others to understand, and why we’re here to help you. Below, we briefly cover:
The application process and common eligibility requirements
Underwriting standards and how they will reference your medical history
Why working with a licensed Long-Term Care Insurance specialist is the best way to ensure you’re navigating the process to maximize your opportunity
Coverage Eligibility and the LTC Insurance Application Process
Long-Term Care Insurance is designed to help you pay for the future cost of long-term health care, such as in-home care, adult day care, assisted living facilities, memory care, and a nursing home.
More and more people are applying for LTC Insurance. They understand that greater longevity and advances in medical science increase their risk of needing help with daily living activities or supervision due to dementia. The likelihood of an individual needing long-term care is high and the cost of care is increasing. Insurance companies need to be careful about the current health of those applying for coverage.
To determine your eligibility for coverage and how much the premium will be, insurance companies need to know your current health status. If you lie about your health on your application, you may be denied coverage or charged higher premiums.
LTC Underwriting Standards & Your Medical History
Underwriting standards change from company to company, each of which will have its own process. This means you could be insurable with Company "A" but not with Company "B."
The good news is, you don’t have to do this guesswork on your own. Long-Term Care Insurance specialists who represent top insurance companies can quickly assess and recommend companies based on your specific needs and conditions.
Speaking with a specialist is the first step to finding the right fit for your insurance.
RELATED: What Is Underwriting In Long-Term Care Insurance?
The specialist will ask you very detailed questions about your health and family history to help determine your eligibility and, if so, with what company. The specialist will then be able to make the proper recommendations to find you the best coverage at the lowest cost.
But…can you lie to the insurance agent and the insurance company and get away with it? You could lie, but it won't be in your best interest to do so, and the insurance company will find out through the underwriting process.
Insurance companies have several ways to verify your health status. In addition to the health questions the specialist will ask and the questions on the application, the insurance company will obtain a lot of information about your health history.
Some companies obtain medical claims data. This data shows the doctors, clinics, and hospitals you visited and the insurance codes attached to each visit. Then the medical records will be ordered, and your prescription history will be reviewed. All of this is in addition to a nurse telephone interview that most insurance companies will order.
In addition, most insurance companies order Medical Information Bureau reports, which would show if you have been declined for insurance coverage in the past.
The insurance company will find out no matter what you say, so you should be honest with the Long-Term Care Insurance specialist in the first place. The specialist should understand the underwriting guidelines to match you with the right insurance company.
Plus, in some cases, lying on a Long-Term Care Insurance application can be considered insurance fraud, which is a crime. Even if the policy was issued, it could harm your ability to get benefits. Although fraud is hard to prove, attempting it is not in your best interest.
What About Pre-existing Conditions?
It’s a common misconception that a pre-existing condition will keep you from being able to obtain Long-Term Care Insurance. Very few LTC Insurance companies have pre-existing health exclusions. You need to have reasonably good health to obtain coverage. However, you don't need to have perfect health.
The deeper truth to this is that there certainly are times when an LTC Insurance application will be denied. But it’s dangerous to assume this without first speaking to a licensed LTC Insurance specialist.
Regardless, as we mentioned earlier, if you’re attempting to lie about the existence of a pre-existing condition to obtain Long-Term Care Insurance, you put yourself at financial and legal risk. It’s also going to be uncovered by the rigorous underwriting process.
If this all seems complicated, it doesn’t need to be. In fact, most applications for LTC Insurance can be handled smoothly. But it requires consultation with someone specifically trained to explain and provide Long-Term Care Insurance options to those eligible.
Long-Term Care Insurance Specialists: Get Answers to Your Questions
Always start your process by seeking the help of an experienced Long-Term Care Insurance specialist. Be sure they ask you many detailed questions, especially about your health and family history. If not, find someone else.
RELATED: Find a Qualified Long-Term Care Insurance Specialist
What To Look For in a Long-Term Care Specialist
The specialist should fully understand the underwriting standards of all the top insurance companies, not just one or two. Premiums and underwriting vary dramatically between companies.
An insurance agent that applies the same recommendations to each person and who doesn’t understand the often vast differences between companies and their underwriting standards is not providing you with all of your options.
The specialist works for you, so be sure you tell them everything. They will explain how to handle the nurse interview and the rest of the underwriting process.
Honesty is the Best Policy
For example, you should be honest during a nursing interview but never volunteer information. However, with the specialist, tell them everything so they can make the proper recommendations.
Regardless, you should now understand that lying on a Long-Term Care Insurance application - or during the underwriting process - is a dangerous way to handle the process.
It’s natural to have concerns, but hiding them won’t lead to the best health outcomes for you. Your long-term care specialist can help you understand your options, and also ease your fears about the process, to help you get the Long-Term Care Insurance that’s best for you. When you’re ready to speak to a specialist, make sure you’re addressing any concerns you have so that you can feel comfortable with your decision.