Complaint Investigation Report

The review of records showed that the LTC insurance company has sent a letter to R1/R1’s responsible party advising of not receiving certain documents on 01/21/2025 and 05/02/2025. In the letter dated 05/02/2025 that was sent to R1's responsible party's address, it states that on 04/09/2025, 05/18/2025, and 05/27/2025 the LTC company requested but did not receive certain information in order to continue processing the claim.

On 05/15/2025, the RP states that facility acted upon the issue and reached out to R1’s LTC insurance.

2 staff members (S1 – S2) were interviewed. S1 started his/her position in mid-February 2025 and S2 started his/her new position in late February – early March 2025.

Based on interview, S1 stated that typically the facility would be informed by the resident’s responsible party if the LTC insurance company is missing forms, as the LTC insurance company communicates directly with the resident and/or responsible party.

S1 and S2 states that they were only informed that R1’s LTC insurance company was missing forms on 05/13/2025 by R1’s responsible party. S1 and S2 denied being informed in March or April, that R1’s LTC insurance company was missing forms. S1 stated to have only received an email from R1’s responsible party regarding issues with the LTC insurance on two occasions, which was on 05/13/25 and sometime last year.

It was stated that upon receiving the email from R1’s responsible party on 05/13/2025, the facility immediately sent the required form to the LTC insurance company and followed up with the LTC insurance company as well to confirm receipt.

Based on interview, 2 out of 2 staff members thought it was the facility’s responsibility to submit all forms to the resident’s LTC insurance companies.