What Are Activities of Daily Living in Insurance?

Health care worker helping someone get dressed
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Definition

The activities of daily living (ADLs) in insurance are the essential tasks people must be able to perform to care for themselves every day. They are dressing, bathing, toileting, eating, continence, and transferring (getting out of bed, into a car, etc.).


A person’s ability or inability to perform ADLs is one factor insurance companies look at when deciding whether they’re eligible for long-term care insurance benefits. It also plays a role in determining whether applicants are approved for certain types of insurance.

Key Takeaways

  • The activities of daily living (ADLs) in insurance are the six essential tasks people must perform to take care of themselves regularly.
  • The six ADLs are dressing, bathing, toileting, continence, eating, and transferring.
  • Insurance companies commonly use ADLs to determine if a person qualifies for long-term care benefits.
  • A person often must be unable to perform at least two ADLs to qualify for long-term care insurance benefits.
  • Inability to perform any ADL also may be used to disqualify an applicant from certain types of insurance policies.

What Are the Activities of Daily Living (ADLs) in Insurance?

The six main ADLs that insurance companies use to determine if a person qualifies for long-term care benefits are:

  • Bathing: The ability to get into and out of the shower or bath and wash oneself sufficiently
  • Continence: The ability to control one’s bladder and bowel movements, or manage a colostomy bag or catheter
  • Dressing: The ability to put on and take off one’s clothing, and any necessary braces, artificial limbs, etc.
  • Eating: The ability to feed oneself
  • Transferring: The ability to move around as needed, including into and out of bed, into and out of a car, etc.
  • Toileting: The ability to get to and from the bathroom, on and off the toilet, and maintain hygiene

When a person can no longer perform some or all of these tasks independently and has long-term care insurance, they should contact their provider to see if they qualify for benefits.

Note

Long-term care insurance coverage is available through dedicated policies, life insurance riders, employee benefits, and Medicaid’s Long-Term Care Services program (in some states).

How Activities of Daily Living Are Used in Insurance

When a person can no longer take care of their needs on a daily basis, long-term care insurance can help cover the costs of getting assistance. Insurance companies that provide long-term care, however, need a way of determining when policyholders qualify for benefits. Enter the activities of daily living. Policyholders typically qualify for long-term care insurance benefits when they can no longer perform at least two of the six ADLs.

However, other qualification requirements can apply. For example, some insurers require policyholders to need hands-on assistance, and won’t approve the need for standby assistance alone. Further, some require a health care practitioner to verify that ADLs can’t be performed and may require that they can’t be performed for a certain amount of time (such as 90 days). You’ll need to read the fine print of your insurance policy or talk to your agent to learn all the details.

Note

Insurers also may use inability to perform some or all of the ADLs as a reason to deny an applicant a policy when reviewing their preexisting conditions, medical records, and exams in the underwriting process.

Example of How an Insurance Company Uses ADLs

If your spouse has a life insurance policy with a long-term care rider, the rider enables your spouse to use part of their death benefit to pay for long-term care services. However, before they can, they’ll need to meet the insurer’s requirements.

For example, let’s say the insurer requires certification from a health care practitioner that your spouse is unable to perform at least two ADLs for at least 90 days. If your spouse is diagnosed with rheumatoid arthritis and hasn’t been able to independently bathe or use the bathroom for the past six months, they should qualify for your long-term care benefits. However, their doctor would need to verify the situation.

ADL vs. IADL

Along with ADL, you may also come across the abbreviation “IADL.” IADL stands for “instrumental activities of daily living.” While ADL refers to the basic personal tasks of daily life, IADL refers to more complex tasks that are still essential; for example, housekeeping, managing money, preparing meals, taking medication, caring for pets, and making necessary trips (going to the grocery store, doctor, etc.). While ADLs are often used to determine eligibility for long-term care insurance benefits, the benefits themselves often include assistance with IADLs.

Frequently Asked Questions (FAQs)

How do you qualify for benefits under the ADL trigger?

A common eligibility requirement for long-term care insurance is when a policyholder can be confirmed to be incapable of performing at least two ADLs independently. However, the requirements will vary from one insurer to the next.

What qualifies as ADLs?

Insurance companies use six main ADLs to determine eligibility for long-term care benefits. They are bathing, toileting, dressing, transferring, continence, and eating.

What activities don't qualify for long-term care insurance?

Anything outside the six listed ADLs will not be considered when you’re applying for long-term care benefits. For instance, if you can’t drive, go grocery shopping, or clean your house, your life may be limited, but those things alone won’t qualify you for long-term care benefits.

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Sources
The Balance uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. South Dakota Division of Insurance. “Long-Term Care Insurance Claims Processes.” Pages 3-4.

  2. Michigan.gov. “Long-Term Care Insurance: Is It Right for You?

  3. South Dakota Division of Insurance. “Long-Term Care Insurance Claims Processes.” Page 8.

  4. State of New Jersey Department of Banking & Insurance. “What You Should Know About … Long-Term Care.

  5. LongTermCare.gov. “What Is Long-Term Care?

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