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Instructions: The purpose of this form is to report all rescissions of long-term care insurance policies or certificates. The purpose of this form is to report all rescissions of long-term care insurance policies or certificates for the preceding calendar year.Longterm Care Insurance Claims Denial Reporting Form. Appendix G. Recission Reporting Form for Long-Term Policies. The purpose of this form is to report all rescissions of long-term care insurance policies or certificates. Appendix B. Personal Worksheet. Replacement of Accident and Sickness or Long-Term Care Coverage. Appendix D, Rescission Reporting Form. Long Term Care Insurance: APPENDIX A. RESCISSION REPORTING FORM FOR. LONG-TERM CARE POLICIES.