Employees and families
Attending Physician Statement: This form must be completed by the physician or treating provider primarily responsible for your care.
Ask him/her to complete Part ll and fax the form to 1-800-447-2498 or mail it to the address on the claim form. Your physician may charge you a fee to complete this form.
Benefit Percent: The benefit percent is the percentage of an employee’s pre-disability earnings that is used to calculate the gross disability benefit. The benefit percentage is chosen by the employer and is noted in the certificate of coverage.
Disability: Disability is defined in the policy. There are several definitions of disability; however the core concept is that, due to a sickness or injury, an employee is unable to perform the material and substantial duties of their occupation as it is defined in the national economy. An employee may also be required to have a certain percentage of their earnings lost due to a disability.
Earnings: The definition of earnings can be found in the policy. Earnings are generally either the amount an employee was making at the time they became disabled or the amount shown on their previous year’s W-2 form. However, there are several definitions of earnings, so please refer to the policy or ask an HR representative for more information.
Eligible/Eligibility: Eligible means someone qualifies to apply for, or enroll in, a certain insurance plan. For example, an employee may have to work a minimum number of hours per week to be eligible for insurance coverage.
Elimination Period: The elimination period is a period of time an employee must be disabled before benefits are paid.
For short-term disability, there is an elimination period for disabilities due to sickness and one for those due to injury. The elimination periods may be the same length, depending on the policy.
The length of the elimination period is chosen by the employer.
Please refer to the certificate of coverage to confirm the elimination period.
Elimination Period (iSTD): Once you are totally disabled, the elimination period is the number of days (stated in your policy) that must elapse before you are eligible to receive benefit payments. Benefits are not payable nor do they accrue during the Elimination Period. For Individual Short Term Disability, there is a different elimination period for disabilities due to a Covered Sickness and disabilities due to a Covered Accident. These elimination periods may be the same length depending on the policy.
Employee Statement: A portion of the claim form to be completed by you. This portion of the claim form can be completed on our secure self service website. Paper forms can be faxed to 1-800-447-2498 or mailed to the address on the claim form.
Exclusions: Disabilities that are not covered by the policy.
Occupation: An employee’s occupation is the occupation they were routinely performing when they became disabled. It includes the material and substantial duties of the occupation as they are usually and customarily performed.
Pre-existing Condition: A pre-existing condition is a condition for which an employee received treatment prior to the effective date of STD coverage.
If a claim is filed within a defined time after the effective date of coverage, a review will be completed to determine if treatment for the condition being claimed was received prior to the effective date of coverage.
The look back period (time prior to the effective date) and the time period after the effective date during which a claim is filed that would necessitate this review are selected by the Employer and noted in the certificate of coverage.
Pre-existing Condition (iSTD): A sickness or physical condition can be considered pre-existing if you had symptoms that would cause a prudent person to seek advice or treatment from a physician; or you received treatment, including prescribed medication, for this condition prior to the effective date of your ISTD coverage. State variations regarding the Pre-existing Condition exist. Please refer to your policy.
When a claim is filed within the first 12 months after the effective date of coverage, Unum will review your medical history to determine if the condition was a pre- existing condition as defined in your policy. If your illness meets the definition of a pre-existing condition, benefits for this condition may not be covered during the first 12 months after the effective date of your ISTD policy.
Total Disability: You are considered to be disabled when you are unable to perform the material and substantial duties of your occupation, not engaged in any other occupation and are under the care of a physician. The definition of disability may vary by state; please check your policy for the definition of Total Disability.
Waiver of Premium: This provision waives the individual short term disability premiums after 90 days of Total Disability, or after the Elimination Period if it is longer than 90 days. For these premiums to be waived your Total Disability must be the result of a Covered Accident or a Covered Sickness.
Waiver of premium may last until the Total Disability ends or after the end of the Maximum Benefit Period (whichever is earlier). You must resume payment of premiums by paying the next premium due to keep your policy in force.