When one of your employees suffers a disabling sickness or injury, it's important that you both feel comfortable with the service and support you are receiving from Unum. This step-by-step guide is designed to make the process easier for you and your employees, enabling us to provide a thorough, fair and objective claim review and to assist with your employee's return to work and productivity.

Please choose the claim submission process your company has elected to use:

• Paper or Fax Claim Submission
• Telephonic Claim Submission (available to employers with 500+ employees; for an additional fee)

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Paper or Fax Claim Submission

1. Make sure your employees have access to copies of Unum's paper claim form. Access this form online using our 5-step questionnaire, or you may request a copy from your Unum service representative.
   
   
2. Direct employee questions about the claim form to assistance with filing a claim page.
   
   
3. You are to complete the "employer statement" section of the claim form (this should take less than 15 minutes), and give it to your employee.*
   
   * It is helpful to include a copy of the employee's job description, or a description of your employee's specific job responsibilities, with the employee section of the claim. This information can be helpful as Unum works with you and your employee to assess opportunities for the employee to return to work and productivity.
   
   
4. Have your employee complete the "employee statement and release of information" section (also known as the authorization). This authorization allows Unum access to medical information related to the claim, while protecting your employee's right to privacy regarding his/her medical records.
   
   
5. Your employee will take the signed authorization and the physician statement section of the claim form to their treating physician, with the request that the physician complete the "physician statement" section.
   
   
6. Once the employee and physician sections of the claim are complete, your employee or the physician can mail the entire claim (including employer's statement, employee's statement, authorization form, and physician's statement) to Unum.*
   
   * Most employers prefer not to submit claims for their employees due to privacy issues related to employee health information.
   
   
   • Short term disability (STD) claims should be submitted to Unum as soon as possible after the onset of the disabling condition or the scheduling of the disabling event (i.e., surgery, maternity leave, etc.) to help ensure the prompt beginning of approved STD benefits.
   • Long term disability (LTD) claims should be submitted no later than four weeks before the end of your LTD elimination period. (The LTD elimination period is the period of time that must pass after the onset of the disability before LTD benefits can begin. See your Unum policy or call your Unum service representative to determine your company's LTD elimination period.)
   
   
7. The submitted claim is entered into Unum's claim system and is reviewed for completeness and clarity. If any information is missing or unclear, a Unum representative will call your employee for clarification.
   
   
8. Based on your employee's disability, the claim is assigned to an appropriate Disability Benefit Specialist (DBS) for handling. The responsibilities of the DBS include checking for contract eligibility for the claim, reviewing the disabling condition and determining potential return-to-work opportunities and timeframes. The DBS will manage these responsibilities in coordination with other individuals as needed, including nurses, physicians, and vocational rehabilitation consultants.
   
   
9. For most STD claims, payment decisions can be made within 5 business days of Unum's receipt of the completed claim. However, if the medical condition is more complicated, STD claim reviews may take up to 30 days. Most LTD claim decisions are made within 35 to 45 business days of receipt of the completed claim. Unum's goal is to always provide a decision as quickly as possible. The submission of complete claim forms and prompt responses to questions or requested information will help to ensure timely claim decisions.
   
   
10. For some STD claims and all LTD claims, the DBS will make a detailed phone call to your employee. During this call, the DBS may talk with your employee about his/her disability and recovery opportunities, discuss contract features and benefits related to the disability, and share service expectations that he or she should have of Unum. This initial call may last 30 to 60 minutes, and will be followed by a mailing to your employee that may include an initial claim receipt verification letter and an easy-to-understand claim process brochure.
    
    
11. If a claim is complex, the DBS might determine that more detailed medical information is needed from your employee's attending physician in order for Unum to make an appropriate payment decision. In this case, the DBS will request the needed information in writing from the physician.
    
    
12. Throughout the claim review process, your employee will be kept up-to-date through phone calls and letters from Unum. Additionally, your employee will be given a toll-free number to use if they need to call Unum. Our claims call centers are staffed from 8 a.m. - 8 p.m. EST. However, interactive voice response information is available 24/7 by calling 1-866-568-2727. Your employees can also check their claim status online at unum.com.
    
    
13. If your employee's claim is approved, the DBS will send a detailed approval letter to notify them of the decision. You will also receive a letter letting you know of the claim approval (view a sample claim approval letter).
    
    
14. If your employee's claim is denied, you will receive a notification of the denial before your employee receives notification. Your employee will receive a detailed letter outlining the denial and his or her right to appeal the claim decision.
    
    
15. If your employee's claim is denied, your employee will have 180 days to appeal in writing to Unum. In the written appeals letter, the employee should include a specific explanation of why he/she disagrees with Unum's decision. This will help us to respond quickly and directly to your employee's specific concerns.
16. All appealed claims are reviewed and evaluated by an independent team of claim professionals, who are given access to all original claim information and data. Decisions to reverse or uphold the original determination, or to require additional investigation, are typically made within 45 days of the appeal.
    
    
17. For approved claims, the DBS will continue to evaluate opportunities for your employee to return to work with your company or, if that is not possible, with another. Clinical and/or vocational rehabilitation resources may also assist. Return-to-work services may not be appropriate for all claimants. Unum will determine when and to what extent these services are appropriate.
    
    
18. If you have integrated STD and LTD through Unum, and your employee remains disabled throughout the STD benefit period, the claim will transition to LTD benefits without additional paperwork or claim submission. If you have LTD benefits with another carrier, make sure you and your employee have completed all appropriate paperwork and claim submissions with that company so that benefit payments can begin on time. If you have STD with another carrier, make sure that the Unum LTD claim is submitted before the end of your LTD elimination period (see item No. 6 under "Paper or Fax Claim Submission").
    
    
19. Most LTD policies include, after a period of time, a change in the definition of disability from "own-occupation" eligibility (meaning your employee cannot work in his or her previous occupation) to "any occupation" eligibility (meaning your employee cannot work in any occupation). If your LTD policy has a change in the disability definition, the DBS will begin to proactively review your employee's claim and his or her abilities against that definition change between 12-24 months. Most changes of definition occur at 24 months.
    
    
20. If your employee has a behavioral health diagnosis, LTD policy language may limit benefits to 24 months. The DBS will research your policy language and will ensure that both you and your employee know any limitations of coverage.
    
    
21. If your employee's disabling condition is catastrophic or expected to be very long-term in nature, Unum has resources available to help your employee qualify for and obtain Social Security Disability Income (SSDI) benefits. Unum's advocacy programs for SSDI benefits are extremely successful; in fact, our success rates for SSDI approvals exceed national averages. Click for more information on our SSDI advocacy program.*
    
    * If your employee is approved for SSDI benefits, the Unum LTD benefit will be reduced by the amount of those benefits.
    
    
22. Your employee's Unum disability benefits will be offset or reduced by any SSDI or other qualifying disability payments that he or she may receive from another source. Benefit offsets are outlined in detail in your Unum policy.
    
    
23. If your LTD policy is fully insured, Unum will not be able to provide you with any medical information related to your employee's claim, without an authorization, due to current privacy laws. However, we can provide claim review status reports, restriction and limitation information, and Social Security advocacy updates as needed.
    

If you have questions about Unum's disability claim process, the role you or your employee play in that process, or about the status of a specific claim, please call 1-866-568-2727.

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Telephonic Claim Submission

1. Provide your employee with Unum's toll-free claims submission number. For most companies, this number is 1-866-568-2727.
   
   
2. Tell your employee to call Unum and report his or her disability. This call will initiate the disability claim.
   
   
3. Your employee's call will be taken by a Unum representative, who will gather all needed information from your employee
   
   
4. The Unum representative will then contact you and your employee's attending physician to gather any additional needed information.
   
   
   • Short term disability (STD) claims should be submitted to Unum as soon as possible after the onset of the disabling condition or the scheduling of the disabling event (i.e., surgery, maternity leave, etc.) to help ensure the prompt beginning of approved STD benefits.
   • Long term disability (LTD) claims should be submitted no later than four weeks before the end of your LTD elimination period. (The LTD elimination period is the period of time that must pass after the onset of the disability before LTD benefits can begin. See your Unum policy or call your Unum service representative to determine your company's LTD elimination period.)
   
   
5. The reported claim is entered into Unum's claim system and is reviewed for completeness and clarity. If any information is missing or unclear, a Unum representative will call your employee for clarification.
   
   
6. Based on your employee's disability, the claim is assigned to an appropriate Disability Benefit Specialist (DBS) for handling. The responsibilities of the DBS include checking for contract eligibility for the claim, reviewing the disabling condition and determining potential return-to-work opportunities and timeframes. The DBS will manage these responsibilities in coordination with other individuals as needed, including nurses, physicians, and vocational rehabilitation consultants.
   
   
7. For most STD claims, payment decisions can be made within 5 business days of Unum's receipt of the completed claim. However, if the medical condition is more complicated, STD claim reviews may take up to 30 days. Most LTD claim decisions are made within 35 to 45 business days of receipt of the completed claim. Unum's goal is to always provide a decision as quickly as possible. The submission of complete claim forms and prompt responses to questions or requested information will help to ensure timely claim decisions.
   
   
8. For some STD claims and all LTD claims, the DBS will make a detailed phone call to your employee. During this call, the DBS may talk with your employee about his/her disability and recovery opportunities, discuss contract features and benefits related to the disability, and share service expectations that he or she should have of Unum. This initial call may last 30 to 60 minutes, and will be followed by a mailing to your employee that may include an easy-to-understand claim process brochure.
   
   
9. If a claim is complex, the DBS might determine that more detailed medical information is needed from your employee's attending physician in order for Unum to make an appropriate payment decision. In this case, the DBS will request the needed information in writing from the physician.
   
   
10. Throughout the claim review process, your employee will be kept up-to-date through phone calls and letters from Unum. Additionally, your employee will be given a toll-free number to use if they need to call Unum. Our claims call centers are staffed from 8 a.m. 8 p.m. EST. However, interactive voice response information is available 24/7. Your employees can also check their claim status online at unum.com.
    
    
11. If your employee's claim is approved, the DBS will send a detailed approval letter to notify them of the decision. You will also receive a letter letting you know of the claim approval (view a sample claim approval letter).
    
    
12. If your employee's claim is denied, you will receive a notification of the denial before your employee receives notification. Your employee will receive a detailed letter outlining the denial and his or her right to appeal the claim decision.
    
    
13. If your employee's claim is denied, your employee will have 180 days to appeal in writing to Unum. In the written appeals letter, the employee should include a specific explanation of why he/she disagrees with Unum's decision. This will help us to respond quickly and directly to your employee's specific concerns.
    
    
14. All appealed claims are reviewed and evaluated by an independent team of claim professionals, who are given access to all original claim information and data. Decisions to reverse or uphold the original determination, or to require additional investigation, are typically made within 45 days of the appeal.
    
    
15. For approved claims, the DBS will continue to evaluate opportunities for your employee to return to work with your company or, if that is not possible, with another. Clinical and/or vocational rehabilitation resources may also assist. Return-to-work services may not be appropriate for all claimants. Unum will determine when and to what extent these services are appropriate.
    
    
16. If you have integrated STD and LTD through Unum, and your employee remains disabled throughout the STD benefit period, the claim will transition to LTD benefits without additional paperwork or claim submission. If you have LTD benefits with another carrier, make sure you and your employee have completed all appropriate paperwork and claim submissions with that company so that benefit payments can begin on time. If you have STD with another carrier, make sure that the Unum LTD claim is submitted before the end of your LTD elimination period (see item No. 4 under "Telephonic Claim Submission").
    
    
17. Most LTD policies include, after a period of time, a change in the definition of disability from "own-occupation" eligibility (meaning your employee cannot work in his or her previous occupation) to "any occupation" eligibility (meaning your employee cannot work in any occupation). If your LTD policy has a change in the disability definition, the DBS will begin to proactively review your employee's claim and his or her abilities against that definition change between 12-24 months. Most changes of definition occur at 24 months.
    
    
18. If your employee has a behavioral health diagnosis, LTD policy language may limit benefits to 24 months. The DBS will research your policy language and will ensure that both you and your employee know any limitations of coverage.
    
    
19. If your employee's disabling condition is catastrophic or expected to be very long-term in nature, Unum has resources available to help your employee qualify for and obtain Social Security Disability Income (SSDI) benefits. Unum's advocacy programs for SSDI benefits are extremely successful; in fact, our success rates for SSDI approvals exceed national averages. Click for more information on our SSDI advocacy program.*
    
    * That if your employee is approved for SSDI benefits, the Unum LTD benefit will be reduced by the amount of those benefits.
    
    
20. Your employee's Unum disability benefits will be offset or reduced by any SSDI or other qualifying disability payments that he or she may receive from another source. Benefit offsets are outlined in detail in your Unum policy.
    
    
21. If your LTD policy is fully insured, Unum will not be able to provide you with any medical information related to your employee's claim without an authorization, due to current privacy laws. However, we can provide claim review status reports, restriction and limitation information, and Social Security advocacy updates as needed.

If you have questions about Unum's disability claim process, the role you or your employee play in that process, or about the status of a specific claim, please call 1-866-568-2727.

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