Lifetime Max


100+ Post Club
This is a simple question that I want to be sure I understand correctly. I had a prospect through email ask what happens if they exceed their lifetime max?

Wasn't sure how to answer this one. Obviously no more benefits will be paid, but are they screwed for the rest of their life?
You have most companies around the 5 mill range but the question is what event would incur such an expense.

Remember outpatient is all capped. You're not getting 2 mill in therapy if you pulled a Christopher Reeve. Facilities like skilled nursing and hospice are also capped.

If you're basically screwed; paralyzed or brain dead like Shivo you need massive home care which no policy covers.

I can't think of much inpatient that would approach even million. They said on Dateline that separating the conjoined twins was close to a million. Mabe if you're a severe burn victim you could possibly spend months in the hospital but check for therapy caps.

Also, a major car accident where you end up in a coma and are in ICU for months could possibly approach lifetime max - but then case management would come in after "X" amount of time and if you progress was being made claims would stop.
I have been in this industry since 1972. The largest claim I have had was $2.5M about a dozen yrs ago when $2.5M was a lot of money.

The 3 most expensive claims are:


Head & spinal cord injuries


My $2.5M was a burn victim.

Very few claims will exceed $1M, so a $3M cap is plenty for most situations. When available, I do try to get clients to buy up to $5M because it is so cheap.

Most folks will run out of money to pay premiums before they ever get to their cap. If they do hit their cap they will most likely qualify for SSDI & Medicare to pick up once policy benefits are exhausted.

Reeve was originally covered by a polcy thru the actors guild, then later SSDI & Medicare.

He did have other assets, and was able to work on a limited basis after his accident to supplement what Medicare did not cover.
Largest claim I've had personally in the last few years was a liver transplant - $460,000 lock, stock and barrel.

The client does however continue on about $1400/month in meds - which is why I'm not a fan of Rx caps.

Carrier reps tell me (probably a lie) that the largest claims they pay are for
neonatal intensive care type stuff for preemies..they say can sometimes top $1,000,000.