How to Complete the Davies Life & Health Monthly Verification Form

The Davies Life and Health monthly verification form, formally the Monthly Verification of Continuing Care, is the document that keeps an active long-term care or disability claim paid month after month. Davies, a third-party administrator handling insurance claims in all 50 states, uses it to confirm that the insured person is still receiving qualifying care, at what level, and at what cost.¹ Return it on time each month, with the facility’s itemized invoice attached, and benefit payments continue without interruption.

What the Form Asks For

The form is built in sections, and each one feeds a specific decision the claims examiner has to make before authorizing the next check.² Gather the information below before you start:

Insured information: policyholder’s first and last name, policy number, and date of birth. California and New York policyholders will see state-specific fraud warning language in this section.
An itemized billing statement from the care facility for the month being verified, which you attach or upload with the form.
Service period: the from/through date range and the insured’s monthly cost for room, board, and level of care. Past-due balances are excluded from this figure.
Facility information: name, email, physical address, phone, and fax.
Dates of service and confinement: initial admission date, discharge date and reason if applicable, and whether the insured was physically in the facility every day of the month. If the insured left at any point, you record departure and return dates, the bed-hold amount charged during the absence, the reason (hospitalization, transfer, therapeutic leave, or other), and the name and address of where the insured went.
Other payer source: whether Medicare, a Medicare Replacement Plan, or Medicaid paid during the month, with the applicable date ranges.
Level of care: nursing care, personal care, independent/no care, or other, plus the facility’s license type (nursing facility, assisted living, residential care, home for the aged, housing with services, retirement community, independent living, or other). If the level of care changed from the previous month, you explain the change.
Signature: name and title of the person completing the form, with a checkbox consenting to an electronic signature.

How to Complete the Form Correctly

In most cases the facility fills this out, not the policyholder, because facility staff have direct access to billing records, admission logs, and level-of-care documentation. If you are a family member or power of attorney managing the claim, coordinate with the facility’s billing department so their numbers match the invoice that goes in with the form.

Get the Monthly Cost Right

The room, board, and level-of-care figure should reflect only the current month’s recurring charges. Do not include past-due balances or one-time fees for ancillary services. Pull the number directly from the facility’s itemized invoice for that billing period, and upload the invoice with the form so the examiner can cross-reference without asking.

If Medicare or Medicaid paid any portion of the month, enter the exact date ranges. Davies uses this to coordinate benefits and calculate the correct payout. Leaving the other-payer section blank when government benefits are involved typically triggers a request for more documentation and delays payment.

Record Every Absence

Many long-term care policies tie benefit eligibility to the insured’s physical presence in the facility. If the insured left for any reason, even briefly, record each departure and return date separately. Include the bed-hold charge the facility applied during the absence and the name and address of wherever the insured went. An incomplete confinement section is one of the fastest ways to have the form sent back.

Flag Any Change in Care Level

If the insured moved from nursing care to personal care, or the other way around, during the month, mark the change and write a brief explanation. Policy benefits often differ by care level. An unreported change can result in an overpayment the insurer will later claw back, or an underpayment you will have to dispute.

Sign the Form

The checkbox authorizing an electronic signature carries the same legal weight as a handwritten one under federal law.³ The signer should be whoever can actually verify the information, usually a billing coordinator or administrator at the facility. If you are a policyholder completing the form yourself, sign with your own name and note your relationship to the claim.

How to Get and Return the Form

Davies makes the form available through its online policyholder portal at dlhpolicylink.com and, for some carriers, through an electronic forms platform. You can also receive it by mail if your communication preference in the portal is set to U.S. Postal Service.⁴

Three ways to send it back:

Portal upload. Log in at dlhpolicylink.com, select the document type from the dropdown (if you are unsure, pick “other”), and upload the file. This is the fastest route, though Davies notes that uploaded documents may take a few days to be processed into the policy records.⁴
Fax. Send it to the fax number printed on your form’s header. The number varies by the insurance carrier Davies is administering for.
Mail. Send to the address on your correspondence from Davies. Use a service with delivery tracking so you have proof of the arrival date.

Questions about the form or your claim go to the customer service number printed on your benefit correspondence or on the “File a Claim” page of the portal.

After You Submit

Davies does not commit to a specific turnaround time. The portal’s help page says only that uploaded documents “may take a few days to be processed into the policy records.”⁴ Once processing is done, the Claim Payments section of the portal shows completed and pending payments along with the invoices under review.

If Davies needs something more, such as a missing invoice or clearer absence dates, you will get a follow-up request through the portal or by mail. Respond quickly to keep the payment cycle on track.

What Happens If the Form Is Late

The specific consequences of a late or missing verification depend on your policy, not on a universal Davies rule. In general, without the completed form the examiner has no basis to authorize the next payment, so your benefit check is held until the paperwork arrives. The longer the gap, the more likely you will be asked for updated medical or facility documentation before payments restart. Treat the due date the way you would treat a bill. A recurring calendar reminder a week ahead is the simplest safeguard.

If Your Benefits Are Reduced or Denied

Many long-term care and disability policies administered by Davies fall under the Employee Retirement Income Security Act (ERISA), the federal law governing employer-sponsored benefit plans. ERISA gives you specific protections when a verification issue, or anything else, leads to a payment dispute. Individual policies purchased outside an employer plan are governed by state insurance law instead, so check your policy documents or ask Davies which rules apply to your coverage.

If a decision goes against you, the plan administrator must send a written notice spelling out the specific reasons in language a non-lawyer can understand.⁵ For disability benefit denials, the notice must also discuss why the administrator disagreed with your treating physicians, any vocational experts who evaluated you, and any Social Security Administration disability determination you submitted.⁶ A denial letter missing these details may itself be a basis for challenging the decision.

You have the right to a full and fair review of any denied claim.⁵ For disability benefits, the plan must allow at least 180 days from the date you receive the denial to file your administrative appeal. Use that time to pull together updated facility records, physician statements, or anything else that answers the reasons given in the denial. You have to exhaust the internal appeal before filing a lawsuit, so skipping it is not an option.

Federal regulations also cap how long the plan can take to decide a disability claim in the first place. The initial decision must come within 45 days of receipt, extendable by up to 30 days, and then another 30 days, if the administrator notifies you in writing before each extension expires and explains what more it needs.⁶ If the administrator asks you for more information during an extension, you get at least 45 days to provide it.

1
Davies North America. Davies Expands Life and Health Claims Capabilities in the US with Acquisition of Disability Management Services, Inc.
2
Davies Life & Health. Monthly Verification of Continuing Care
3
Office of the Law Revision Counsel. 15 USC 7001 – General Rule of Validity
4
Davies Life & Health. Help Guide
5
Office of the Law Revision Counsel. 29 USC 1133 – Claims Procedure
6
eCFR. 29 CFR 2560.503-1 – Claims Procedure