Quick Answer
An exception or an exclusion is a defined situation where a Long-Term Care Insurance company does not have to pay long-term care benefits to the insured individual.
Detailed Answer
An exception or an exclusion in Long-Term Care Insurance is when the company legally does not have to pay benefits. Every LTC Insurance policy has specific conditions where they will not pay benefits.
These situations include care needed as a result of an act of war, intentional or self-inflicted injury, or care needed due to alcoholism or drug addiction.
Exclusions and exceptions vary by insurance company. However, these tend to be limited and well-defined. It's illegal for companies to refuse to pay benefits for no reason or reasons not previously outlined in the policy.
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