# Independent review of a long-term care benefit-trigger denial, state by state

Claim Back guide · updated October 25, 2026 · https://claimback.lapla.si/guides/long-term-care-independent-review

In some states, when a long-term care insurer keeps its decision that the insured person doesn’t meet the policy’s benefit trigger, you can ask for an independent review: a reviewer that isn’t the insurer decides whether the trigger was met. These are the five states where we’ve read the rule itself. Other states may have one too; we haven’t checked them yet.

- **Ask within: 120 days**, in MT, OR and PA; 180 in AK; 60 in IA
- **Decided in: 30 days**, after the reviewer gets the case
- **Who pays: The insurer**, in MT, OR and PA; its reasonable fees in IA

## What it covers

Only the benefit-trigger question: whether the insured person needs enough help with daily activities, or has cognitive impairment severe enough, to meet the policy’s trigger. A denial for another reason, such as the elimination period, isn’t covered.

You can ask only after the insurer’s own appeal is over and it has kept its decision.

## Who can ask

The insured person, or in Montana, Alaska, Oregon and Pennsylvania their authorized representative: someone they’ve given written consent to, someone authorized by law to consent for them, or a family member when they can’t give consent. In Iowa the insured person files the request.

## Montana

- **Ask:** within 120 calendar days after you receive the insurer’s written notice of its final internal appeal decision, in writing, to the insurer.
- **Who pays:** the insurer.
- **Decision:** within 30 calendar days of the reviewer getting the case. It is final and binding on the insurer.
- **Rule:** [Mont. Admin. R. 6.6.3130](https://www.law.cornell.edu/regulations/montana/Mont-Admin-r-6.6.3130).

## Alaska

- **Ask:** within 180 calendar days after you receive the insurer’s written notice of its final internal appeal decision, in writing, to the insurer.
- **Who pays:** the copy of the rule we could read is garbled at this point, so we don’t say.
- **Decision:** within 30 calendar days of the reviewer getting the case. It is final and binding on the insurer.
- **Rule:** [3 AAC 28.585](https://www.law.cornell.edu/regulations/alaska/3-AAC-28.585).

## Iowa

- **Ask:** within 60 days after you receive the insurer’s internal appeal decision, in writing, to the Iowa insurance commissioner, not the insurer.
- **Who pays:** the insurer pays the reviewer’s reasonable fees and costs.
- **Decision:** within 30 days of the reviewer receiving both sides’ information. It is binding on the insurer. You can ask the district court of your county to review it within 15 business days.
- **Not covered:** group policies governed by the federal Employee Retirement Income Security Act (ERISA).
- **Rule:** [Iowa Code § 514G.110](https://www.legis.iowa.gov/docs/code/2026/514G.pdf).

## Oregon

- **Ask:** within 120 calendar days after you receive the insurer’s written notice of its final internal appeal decision, in writing, to the insurer.
- **Who pays:** the insurer.
- **Decision:** within 30 calendar days of the reviewer getting the case. It is final and binding on the insurer.
- **Which policies:** those issued or renewed after July 1, 2012.
- **Rule:** [OAR 836-052-0768](https://www.law.cornell.edu/regulations/oregon/Or-Admin-Code-SS-836-052-0768).

## Pennsylvania

- **Ask:** within 120 calendar days after you receive the insurer’s written notice of its final internal appeal decision, in writing, to the insurer.
- **Who pays:** the insurer.
- **Decision:** within 30 calendar days of the reviewer getting the case. It can be appealed to a court within 60 days, and the court starts from a presumption that the reviewer’s decision is right.
- **Not covered:** group policies governed by ERISA.
- **Rule:** [Insurance Company Law § 1111.1 (2010 Act 51)](https://www.palegis.us/statutes/unconsolidated/law-information/view-statute?txtType=PDF&SessYr=2010&SessInd=0&ActNum=0051).

## Utah

Utah’s independent review rule for benefit-trigger decisions (R590-285-25) covered limited long-term care insurance, and the Utah Insurance Department lists that rule as repealed on May 6, 2026. Utah’s main long-term care rule has no independent review section. We treat Utah as not yet checked.

## Everywhere else

We haven’t verified a state independent review yet. Follow the appeal steps in the insurer’s letter and the policy, and consider a complaint to your state’s insurance department. When you send us a letter, a person checks your state’s rules before anything is sent.

## Sources

- [Mont. Admin. R. 6.6.3130 — Appealing an insurer’s determination that the benefit trigger is not met](https://www.law.cornell.edu/regulations/montana/Mont-Admin-r-6.6.3130) (Montana (via Cornell LII))
- [3 AAC 28.585 — Appealing an insurer’s determination that the benefit trigger is not met](https://www.law.cornell.edu/regulations/alaska/3-AAC-28.585) (Alaska (via Cornell LII))
- [Iowa Code chapter 514G — Long-Term Care Insurance Act (514G.109, 514G.110)](https://www.legis.iowa.gov/docs/code/2026/514G.pdf) (Iowa Legislature)
- [OAR 836-052-0768 — Appealing an insurer’s determination that the benefit trigger is not met](https://www.law.cornell.edu/regulations/oregon/Or-Admin-Code-SS-836-052-0768) (Oregon (via Cornell LII))
- [Act of July 9, 2010, No. 51 — Insurance Company Law §§ 1103, 1111.1](https://www.palegis.us/statutes/unconsolidated/law-information/view-statute?txtType=PDF&SessYr=2010&SessInd=0&ActNum=0051) (Pennsylvania General Assembly)
- [Utah Insurance Rules (R590-285 repealed 05-06-2026)](https://insurance.utah.gov/consumers/legal-resources/rules/) (Utah Insurance Department)
- [Utah Admin. Code R590-285-25 — Independent review (limited long-term care insurance)](https://www.law.cornell.edu/regulations/utah/Utah-Admin-Code-R590-285-25) (Utah (via Cornell LII))

This guide explains the published rules; it isn’t legal advice. Where a notice says something different, follow the notice.