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To file a claim for short term disability or long term disability benefits, your claim forms must be completed in their entirety. Your employer can inform you whether the forms should be sent to your insurance company or if they may be sent directly to Disability RMS. A complete claim consists of an Employee’s Statement, an Employer’s or Administrator’s Statement, and an Attending Physician’s Statement. You also must complete an Authorization for the Release of Information so we can obtain necessary information to evaluate your claim for benefits. Your failure to submit any of these forms could cause a delay in your benefits or result in the denial of your claim.
When we receive your claim, it will be assigned to an experienced, professional Case Manager / Case Specialist. The Case Manager / Case Specialist will conduct a fair and thorough investigation and evaluation of your claim. The Case Manager / Case Specialist coordinates medical reviews with Registered Nurses and Physicians, and coordinates vocational reviews with Vocational Consultants.
You will be provided with a toll free number to connect you directly with the Case Manager / Case Specialist assigned to manage your claim.
Contact your employer for any short term disability or long term disability policy/certificate requests.
In most disability policies, the definition of disability is based on whether your medical condition prohibits your ability to work. It may be based on your ability to perform your own occupation or it may be based on your ability to perform any gainful occupation. Please refer to the specific language in your policy. We therefore need a job description and sometimes other work related information in addition to medical information to evaluate your claim for disability benefits.
We may offer vocational assistance, solely at our discretion, if we determine that those services are appropriate. Onsite vocational consultants who have a network of rehabilitation professionals throughout the country are available to assist with employee rehabilitation, retraining, and workplace accommodations.
An elimination period is a period of continuous disability that must be satisfied before short term or long term disability benefits begin. No benefits are payable during the elimination period. Your first benefit period begins on the date your elimination period ends. You do not need to wait until the end of the elimination period before you submit your claim.
The benefit periods are defined by your policy. Short Term Disability typically has weekly benefit periods. The benefit periods for Long Term Disability Benefits are generally monthly. If your claim is approved and the elimination period has been satisfied, benefits are paid at the end of each benefit period. For example, a payment for the benefit period extending from January 1st to February 1st would not be payable until approximately February 1st.
Premiums are typically waived if it is determined that benefits are payable. The date premium waiver begins depends on the specific policy wording.
Some disability policies provide benefits if you are able to return to work at a reduced capacity. If your policy provides partial benefits, your benefit payments may continue if you return to work subject to certain conditions. Factors that may affect the benefit payable and the duration of partial benefits may include, but are not limited to, your level of work capacity and loss of actual or potential earnings.
Some disability policies offer a survivor benefit payable to your eligible survivor, subject to meeting your policy’s eligibility requirements. If your plan offers a survivor benefit, eligible survivor is typically defined as your spouse; and if your spouse is deceased, your children (may be subject to an age limit). If you do not have an eligible survivor, the benefit may be payable to your estate. This could vary based on the terms of your policy.
Depending on the individual circumstances of a claim, we may offer the assistance of a Social Security advocate to assist with the process. In many group disability policies, benefits are reduced by any award of past due and monthly Social Security benefits. Any benefit overpayment created due to the receipt of Social Security benefits must be repaid in full upon receipt of the Social Security award. The overpayment will be reduced by any fees paid to a Social Security attorney or advocate.
An Employee Assistance Program (EAP) is a confidential program designed to assist you in identifying issues that are impacting your life and creating solutions to help you to be healthier, happier, and more productive. Please contact your employer to inquire about any EAP service you may have access to.