This 1099-R appears to be an annuity payment from a private insurer and not an LTC payment.  Chances are that the taxable amount is interest this person earned on the annuity investment.  Your client should have received a 1099-LTC for the payment(s) she would have received from her LTC carrier.  Depending on her receipt mechanism, she may need to search on the provider's website to pull that information versus receiving it in a paper medium.