CIPR 6.7.2 Claims handling — long term care insurance contracts

(1) If a QFC insurer receives a claim under a long term care insurance contract, it must respond promptly by providing the policyholder, or the person acting for the policyholder, with:
(a) a claim form, if the insurer requires a claim form to be completed;
(b) a summary of the insurer's claims-handling procedures; and
(c) appropriate information about the medical criteria that must be met and any waiting period that applies under the terms of the contract.
(2) As soon as practicable after receiving the claim, the insurer must inform the policyholder, or the person acting for the policyholder:
(a) for each part of the claim that it accepts — whether the claim will be settled by paying the policyholder, by paying another person to provide goods or services, or by providing goods and services; and
(b) for any part of the claim that it rejects — why the claim has been rejected and whether any future rights to claim exist.
Derived from QFCRA RM/2019-2 (as from 1st January 2020).