Time for an update so this can potentially help others fighting with LTC in the future.
Looking at the advice posted here, as well as talking to some local people who deal with LTC claims, before jumping straight to a lawyer, we gathered documentation and submitted John Hancock's appeal document. I submitted 2 letters from 2 different doctors who specialize in senior care and dementia. They both clearly indicated my MIL has dementia and possibly Alzheimer type and that she is in need of full time supervision. (We talked about brain scans, strokes, etc and the primary doctor is working on setting up those referrals.) John Hancock's appeal document has small sections to state the reasons why we are appealing. We created a 4-page document with a numbered list indicating many Dementia/Alzheimer behaviors she is displaying and included dates when many of them happened. (i.e. Forgetting her name or how to spell it; responding "Yes Mommy" and "Yes Daddy", Unable to manage her meds since X date, etc.) My LOML and I both signed that document and had it notarized.
After submitting the documentation & cover letter using 2 different methods, I called them 6 days later to confirm they received it. I asked for a US representative. She confirmed it was received and that a confirmation letter was generated "today" and would be mailed from the Appeals Dept. No surprise, we have yet to receive the letter. Once again, we all know the person answering the phone was a low-wage call center. She is not to blame. She confirmed that all that it should take to trigger the LTC is a letter from her doctor indicating she has dementia and that she does not need to have two ADL issues to qualify. In a roundabout way, she responded that the doctor letter sent on 3/10/22 was ignored because they deny all initial claims.
She also said that the Appeals Dept will take the FULL 30 days to respond on whether or not they accept the claim. They will not approve it any sooner. The actual policy documentation says they decide "promptly, and usually not later than 60 days...."
Today I have been working on the Qualification Period portion of the policy. The policy has a 90 day Qualification Period before they trigger the benefits. The US rep said the Appeal Dept will determine what date that will be. It could be the June/July 2022 date they approve the claim, or in March when I was finally able to upload a claim, or potentially as far back as January when I started this whole nonsense. I am gathering proof of payment and invoices for the Long Term Care facility dating back to June 2021 just to have it ready for another fight. The actual policy says "in no event will the date determined be earlier than 12 months before the date we receive your completed authorization form." The policy also indicates John Hancock will provide an "approved authorization form" to fill out for the benefit trigger, yet no surprise, they never mailed that out either. Nor is it available online. Which once again requires another phone call while being stuck on hold for 30-50 minutes before someone outside the US answers.
Once again, we are documenting everything we do with John Hancock.
I read recipes the same way I read science fiction. I get to the end and I think, "Well, that’s not going to happen."