Activities of daily living: how disability is assessed for a claim
Long-term care payouts hinge on a formal test of six specific activities of daily living, not a general sense of frailty. Here is what the test measures and how the assessment actually runs.
Long-term care insurance, whether it is CareShield Life or a private supplement layered on top, does not pay out because someone is generally frail, elderly or unwell. It pays out because a formal assessment finds the person cannot perform a specific number of activities of daily living, commonly abbreviated as ADLs. Understanding exactly what those activities are, and how the assessment that measures them actually runs, is the difference between anticipating a claim correctly and being surprised by the result.
The six activities, precisely defined
Under CareShield Life, the six activities of daily living are defined with a level of precision that matters at claim time:
- Washing. The ability to wash in the bath or shower, including getting into and out of it, or to wash by other means.
- Dressing. The ability to put on, take off, secure and unfasten all garments, and any braces, artificial limbs or medical appliances, as needed.
- Feeding. The ability to feed oneself food once it has been prepared and made available.
- Toileting. The ability to use the toilet, or to manage bowel and bladder function using protective undergarments or surgical appliances if needed.
- Walking or moving around. The ability to move indoors from room to room on level surfaces.
- Transferring. The ability to move from a bed to an upright chair or wheelchair, and back again.
A claim under CareShield Life requires an assessor to find that the person is unable to perform at least three of these six. Monthly payouts continue for as long as the person remains unable to perform three or more; if a later reassessment finds improvement to below that threshold, payouts stop. Private long-term care supplements generally use the same six activities as their reference point, though some pay a partial benefit once a person cannot perform two of the six, rather than waiting for three. This difference in trigger point is one of the more consequential details to check when comparing a supplement, since it changes whether a moderate disability produces any payout at all.
Who carries out the assessment, and what it involves
For a CareShield Life claim, the assessment is not done by a family doctor or a general practitioner; it must be carried out by an assessor accredited by the Ministry of Health, who can be found through the Agency for Integrated Care. The assessment can be arranged either at a clinic or as a house call, and a fee applies, though the fee for a person's first CareShield Life assessment is waived, and the full fee is reimbursed alongside the first payout if the claim is successful. Subsequent assessments, for example a reassessment after some recovery or further decline, are charged directly by the assessor.
This structure matters practically: because the assessment requires a specific, accredited professional rather than any doctor's note, it is worth arranging the assessment through the correct channel from the outset rather than assuming a general medical report will substitute for it.
Why the definition, not the diagnosis, drives the outcome
A medical diagnosis, a stroke, advanced dementia, a severe fall, is often the event that leads someone to seek an assessment, but the diagnosis itself is not what triggers a payout. Two people with the same diagnosis can be assessed differently depending on how much functional ability each has retained. This is why the LIA's own description of long-term care insurance stresses that the minimum number of ADLs a person cannot perform, and how each activity is defined, varies from policy to policy, and that payment stops if the number of activities the person cannot perform falls back below the policy's stated minimum. It also typically involves a waiting period after the disability first arises before payouts begin, which is a separate check from the ADL count itself.
What this means when comparing cover
Because payout eligibility is entirely defined by this functional test, a few things are worth confirming before assuming a policy will respond the way you expect:
- The exact ADL trigger the policy uses, three of six, two of six, or a graded scale with different payouts at each level.
- Whether the definitions match the standard CareShield Life wording or use a different formulation, since minor wording differences can change how an assessor scores a borderline case.
- Whether reassessment can reduce or stop a payout, and how often reassessment happens under the policy.
Our coverage gap check can help you see how your current long-term care cover, if any, is structured around this test.
Talk to an advisor
Reading a long-term care policy's ADL wording against your own or a family member's situation is easier with someone who has seen how assessments are actually scored in practice. A licensed advisor can walk through this with you before a claim is needed. Use the portal's advisor matching to find one, or ask our assistant to compare how two policies define the same activity.
Sources
This content is educational information from a licensed advisor, not financial advice. Product details vary by insurer — verify specifics with an advisor.
