# COMAR Title 31 — Maryland Insurance Administration

## Subtitle 14 — Long-Term Care

### Chapter 01 — Long-Term Care Insurance

#### Regulation .32 Claims Denial Reporting Form.

*COMAR 31.14.01.32*

The following form is to be used for reporting claim denials made by each insurer as required by Regulation .24G of this chapter:

For the State of

Company Name: __________________________ Due: June 30 annually
          
          
            Company Address: _________________________________________
          
          
            Company NAIC Number: ____________________________________
          
          
            Contact Person: _________________ Phone Number: ______________
          
          
            Line of Business: _____________ Individual ________ Group

Instructions

The purpose of this form is to report all long-term care claim denials under in force long-term care insurance policies. “Denied” means a claim that is not paid for any reason other than for claims not paid for failure to meet the waiting period or because of an applicable preexisting condition.

StateData
            NationwideData1
          
        
        
          
            1
            Total Number of Long-Term Care Claims Reported
            
            
          
          
            2
            Total Number of Long-Term Care Claims Denied/Not Paid
            
            
          
          
            3
            Number of Claims Not Paid due to Preexisting Condition Exclusion
            
            
          
          
            4
            Number of Claims Not Paid due to Waiting (Elimination) Period Not Met
            
            
          
          
            5
            Net Number of Long-Term Care Claims Denied for Reporting Purposes (Line 2 Minus Line 3 Minus Line 4)
            
            
          
          
            6
            Percentage of Long-Term Care Claims Denied of Those Reported (Line 5 Divided By Line 1)
            
            
          
          
            7
            Number of Long-Term Care Claim Denied due to:
            
            
          
          
            8
            • Long-Term Care Services Not Covered under the Policy2
            
            
          
          
            9
            • Provider/Facility Not Qualified under the Policy3
            
            
          
          
            10
            • Benefit Eligibility Criteria Not Met4
            
            
          
          
            11
            • Other

1 The nationwide data may be viewed as a more representative and credible indicator where the data for claims reported and denied for your state are small in number.

2 Example — home health care claim filed under a nursing home only policy.

3 Example — a facility that does not meet the minimum level of care requirements or the licensing requirements as outlined in the policy.

4 Examples — a benefit trigger not met, certification by a licensed health care practitioner not provided, no plan of care.