We've put together a list of some of the most common questions we receive from
our customers as they begin the claim process. Select a claim type for FAQs.
Back to top
Back to top
Q. How does an employee file a claim?
To notify us of a disability income protection claim, your employee will need
to submit a claim request. You or your human resources department will give the
employee the appropriate claim form. Or, if you offer for telephone submission
of claims, you or the human resources department will provide the employee with
a toll-free number and specific instructions for calling in the claim.
The claim form includes everything your employee will need for a claim request,
including:
- Information you the employer will complete
- Information the employee will complete
- Information your employee's physician will complete
- An authorization form that will enable us to gather additional information as
it becomes necessary.
Back to top
Q. Who will review the claim?
Once we receive a claim request (including all four parts mentioned above),
your employee will be provided with direct access to a disability benefit
specialist (DBS) who will personally handle his/her needs. The DBS, an
individual trained in specific types of disability, will evaluate the full
nature and potential length of your employee's time away from work, will
arrange payment of the financial benefits for which he/she qualifies, and will
begin working with your employee toward his/her recovery and return-to-work
goals, as appropriate. Also, depending on the size of your company, we offer
dedicated claim management teams and extensive call center support to meet your
company's unique requirements.
Back to top
Q. Is anyone else involved in the review process?
When appropriate, the disability benefit specialist will call you and your
employee's attending physician to better understand the employee's condition
and potential for recovery. Our physicians, nurses, case managers and
vocational rehabilitation consultants support our disability benefit
specialists and may also be in touch with the attending physician. These
professionals may provide review of the medical, occupational and
rehabilitative information for the claim, and they may also offer to assist
your employee in returning to work, if appropriate.
Back to top
Q. When will an employee know about his/her
benefits?
For most short term disability (STD) claims, payment decisions can be made
within five business days of Unum's receipt of the completed claim.
With some conditions, such as standard maternity leave or a recovery following
a routine surgery, his/her benefits may begin almost immediately. If the
medical condition is more complicated, however, an STD claim review may take up
to 30 days. Most long term disability (LTD) claim decisions are made within 35
to 45 business days of receipt of the completed claim. If we need additional
information, and therefore require more time to make a claim decision, we will
provide your employee with a written update on the claim status at a minimum of
every 30 days until decided. 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.
Back to top
Q. What if the employee has questions about a claim?
Throughout the claim review process, your employee will be kept up-to-date
through both phone calls and letters. Furthermore, during his/her first
conversation with a Unum disability benefit specialist, your employee
will receive a toll-free number that can be used whenever he/she needs to reach
the DBS with questions or concerns about the claim. Our claims call centers are
staffed from 8 a.m. - 8 p.m. EST. Interactive voice response information is
available 24/7.
Back to top
Q. How will the employee know when he/she is ready
to go back to work?
Because most disabilities are not permanent in nature, we offer your employees
return-to-work support in addition to providing them with financial benefits.
Return-to-work potential is part of the claim evaluation from the start. When
needed, we may partner with your employee and/or you on transitional work
schedules, modification of the workspace or an investment in additional
training that will enable your employee to return to the workforce. At the
appropriate time, a vocational rehabilitation consultant may be assigned to
assist in the transition back to work.
Back to top
Q. What happens if the employee is out of work for a
long time?
If the claim is or becomes long-term meaning usually that your employee will
be out of work for more than 90 days the disability benefit specialist will
stay in contact with the employee, the attending physician and you as needed,
and will continue to monitor the progress of your employee's medical condition.
Periodically, depending upon the specific circumstances of the claim, we will
reassess your employee's eligibility for benefits. With more serious conditions
that could mean long-term inability to work, we will help your employee
understand additional benefits that may be available to him/her, and, if
applicable, to other members of his/her family through Social Security
Disability Income (SSDI). We can help your employee apply for these benefits
and assist him/her throughout the approval process. Unum's advocacy
programs for SSDI are extremely successful; in fact, our success rates for SSDI
approvals exceed national averages.
Back to top
Q. What happens if the employee disagrees with
Unum's decision on a claim?
Our claims process is designed to ensure that your employee's claim receives
thorough, fair and objective evaluation. In addition, numerous safeguards are
in place throughout the process to ensure the integrity of decisions that
result from our evaluation. If we determine that benefits are not payable
either in whole or in part, your employee will have 180 days to appeal in
writing. All appealed claims are reviewed and evaluated impartially 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, per ERISA guidelines.
Back to top
Q. Is this material available for me to
distribute to my employees?
Yes, your employees can access this information at www.unum.com/claims, or you may order it in brochure format
through your Unum account manager. The form number for this brochure
is G-73899.
Back to top
Q. Is there specific information available for
maternity claims?
Yes, click here to access a
flyer of frequently asked questions for maternity disability leave.
Back to top
When one of your employees is seriously injured, diagnosed with a terminal
illness, or dies, the employee's family looks to you to help answer their
immediate questions and concerns about their claim. Our responsive benefits
specialists are just a phone call away if you need assistance at any time
during the claim process. We will ensure that the claim is processed fairly and
promptly.
We hope the information below simplifies the life claim process for you and for
those you serve. If you need additional assistance, please contact the Benefits
Center at 800-858-6843.
Q: Do you provide information specifically for beneficiaries
online?
A: Yes. We offer information that can help your employee and their
family understand our life claim process. We recommend you direct them to What can you expect if you file a life claim? A helpful Q&A for
beneficiaries on our website
Back to top
Q: How do I get a life insurance claim process started?
A: As the group policyholder, you must first complete a Notice of Claim form
for each life, accidental death or dismemberment or accelerated benefit
insurance claim. You can receive a copy of the form by calling the Benefits
Center at Unum at 800-858-6843.
Back to top
Q: In addition to the Notice of Claim form, what other
documentation is required?
A: On all life insurance claims, you will need to provide the following
documentation:
- employment history
- photocopy of the death certificate (requested from the family of the deceased)
- copy of the original enrollment form
- beneficiary change forms (if applicable)
- if the beneficiary is the estate of the insured, a copy of the court
appointment naming the executor, administrator or personal representative
- if the named beneficiary died before the covered employee died, a copy of the
deceased beneficiary's death certificate and name of the contingency
beneficiary. In certain circumstances you may be contacted to provide
additional information such as salary verification to complete the eligibility
determination.
Back to top
Q: Who should sign the Notice of Claim form?
A: The signature in section 2 of the Notice of Claim form should be that of the
person your company or organization has authorized to verify that all
information contained on the form is accurate. This person may be the benefits
manager or an executive of the company. The person that signs the form must be
available for follow-up information and to verify information during the claim
process. If there is a particular benefits assistant or staff person
responsible for addressing follow-up questions, please indicate this along with
his or her contact information on an attached cover sheet.
Back to top
Q: What exactly is meant by dismemberment?
A: As defined in the contract, dismemberment is the loss of a hand,
foot, finger or toe or loss of eyesight in one or both eyes due to an accident.
If accidental death and dismemberment coverage is inforce, benefits are paid to
the covered employee in predetermined or scheduled amounts, in the event of one
or more of these specific types of injuries. This claim requires the Notice of
Claim form and its related documentation, and copies of the attending
physician's office notes related to the injury.
Back to top
Q: What is an accelerated benefit claim?
A: An accelerated benefit is a portion of the life insurance benefit available
to your covered employee or insured dependent when he or she is diagnosed with
a terminal illness. The terminally ill individual must be diagnosed as having a
life expectancy of 12 months or less. This claim requires a Notice of Claim
form and copies of the attending physician's medical records that deal with the
terminal condition. Please note that there are no fees as a result of
requesting the accelerating the accelerated benefit option. Between the insured
and the beneficiary, we pay 100% of the benefit.
Back to top
Q: Where do I send the completed claim forms and
documentation?
A: The completed form and all other documentation should be collected
and faxed to Unum's Benefits Center at 207-575-6096. The forms can
also be mailed to:
Group Life/Special Risk Benefits Center
P.O. Box 9061
Portland, ME 04104-5046
Back to top
Q: If I have questions about an employee's life, accelerated
benefit or AD&D claim, who can I call?
A: Unum will notify you in writing when we have received your
completed claim request. This initial letter will include a toll-free number to
a designated Unum Benefits Center claim specialist who will be
responsive to your questions or concerns. They are specifically trained to
handle life claims and survivor issues. If you have questions while completing
the forms, please contact us at 800-858-6843.
Back to top
Q: How quickly can I expect to hear from Unum about
the claim?
A: Most life claims (more than 80%) are paid within five business days of our
receiving the completed claim forms, attachments and appropriate documentation
from you. Accidental death and dismemberment claims may require additional time
to process the information. If we are unable to make a formal decision within
this timeframe, we will notify you and the beneficiary in writing with the
reason for the delay. We copy the beneficiary on all communications with you.
Back to top
Q: If I find that the designated beneficiary died before my
employee, what do I do?
A: It is very important to keep up-to-date beneficiary designation records for
your employees. However, sometimes the designated beneficiary dies before the
employee, or in some cases, at the same time as the employee. If the designated
beneficiary dies before the employee, you will need to obtain a copy of the
deceased beneficiary's death certificate from his or her family. You will also
need to provide the name and Social Security number of any secondary or
contingent beneficiary you have on record. These will be listed on your
employee's most recent beneficiary designation form. If no secondary or
contingent beneficiaries were designated, Unum may choose to pay the
benefit to the deceased employee's probate estate established by a court. If no
probate estate is established, Unum may choose to pay the benefit to
the spouse, children, parent or siblings. Submit all beneficiary documentation
along with the Notice of Claim form.
Back to top
Q: How will the benefits be distributed?
A: Benefit amounts that are less than $10,000 are paid to the beneficiary in a
lump sum check. Benefits totaling $10,000 or more will be deposited into a
secure interest-bearing Unum Security Account that the beneficiary can
access at any time. This gives the beneficiary the choice of immediately
withdrawing the entire benefit amount in one lump sum, or making periodic
withdrawals as needed. The beneficiary will receive draft checks and, in
certain cases, a debit card to make withdrawals from the account. The
beneficiary will receive a monthly statement that will reflect any account
drafts or withdrawals. There are no additional fees for these services. This
Security Account gives the beneficiary the time needed to deal with an
emotional life event, and also offers the time needed to review personal
finance planning priorities and decisions. If the benefit amount is not
immediately withdrawn, a beneficiary should be designated. If you need a
beneficiary designation form, call the Benefits Center at 800-858-6843.
Back to top
Q: Where can my employee's family turn with the financial
questions and decisions they are now faced with?
A: We offer a confidential and objective one-on-one survivor financial
counseling services1 at no additional cost to you or your employees.
These services are provided by one of the nation's oldest and largest financial
counseling firms, The Ayco Company L.P. The company will not attempt to sell
the family or participants any products or services. It is designed to
coordinate with but not replace the efforts of human resource personnel,
bankers, attorneys, CPAs or other financial or investment counselors. When a
life claim is approved, we immediately notify The Ayco Company. Ayco will call
the beneficiary to offer survivor financial counseling services. These
counselors not only have financial planning expertise, but also sensitivity to
and knowledge of survivor issues. Following a conversation with the
beneficiary, the counselor will recap all the major issues discussed and mail a
comprehensive written plan to the participating beneficiary.
Back to top
Q: How long does the family have access to these financial
counseling services?
A: A financial counselor will be available by phone for continued assistance
for six months after the initial conversation. The beneficiary will be provided
with a convenient toll-free phone number to follow-up on any questions or
concerns.
Back to top
Q: Is the financial counseling service available to an
employee or employee's dependent if he or she is diagnosed with a
life-threatening illness?
A: To be eligible, the covered family member must be diagnosed with a terminal
illness that results in a life expectancy of 12 months or less. The family can
contact Unum's Benefits Center at 800-858-6843 to arrange for this
service.
Back to top
Q: What happens if there is a disagreement with
Unum's decision on a claim?
A: Our claim process is designed to ensure that each claim receives a thorough,
fair and objective evaluation. In addition, numerous safeguards are in place
throughout the process to ensure the integrity of decisions. If we determine
that benefits are not payable, the claimant may appeal the decision by
requesting a separate, impartial review from our quality performance support
unit. The employee or beneficiary will be notified by mail if the claim is
denied and this letter will include the contact information they will need if
they chose to appeal.
Back to top
We understand the important role Long Term Care (LTC) insurance benefits play
in helping an individual who is unable to live independently. That's why our
experienced and responsive benefit specialists are committed to providing
claimants with thorough, fair, objective and prompt claim decisions. We hope
the following information on our long term care claims is helpful. If you have
any questions, please call our Benefits Center during regular business hours at
800-693-4988.
Q: Who is considered chronically ill or disabled under my
employee's long term care policy?
A: A chronically ill or disabled person is unable to perform at least two
activities of daily living (ADL's)* without substantial*
assistance from another person. These activities include bathing, dressing,
toileting, transferring, continence and eating. The ADL loss must be expected
to last for at least 90 days, as certified by a licensed health care
practitioner.* The ADL loss must be re-certified every 12 months.
Being chronically ill or disabled may also include a severe* cognitive
impairment that requires substantial supervision by another person to protect
the disabled person from threats to his or her health and safety. Services must
be provided according to a written plan of care developed by the individual's
licensed health care practitioner.*
* The language in italics is specifically defined by federal law to be used with
any information pertaining to plans that are intended to be tax-qualified.
Back to top
Q: What is an elimination period?
A: The elimination period is a specific number of days during which no
long term care benefits are payable by Unum.
Back to top
Q: Must my employee satisfy an elimination period before
filing an LTC claim?
A: No, your employee is not required to satisfy an elimination period
prior to filing a long term care claim. Long term care claims should be filed
as soon as your employee or his or her insured family member begins receiving
long term care.
Back to top
Q: Where can I get a claim form for my employee to
complete?
A: You can access a long
term care claim form on our website. You or your employee can also call
our Benefits Center at 800-693-4988, and we will fax or mail a claim form to
you or your employee within two business days.
Back to top
Q: Who completes the claim form?
A: Due to Unum's privacy policies and HIPAA (Health Insurance
Portability and Accountability Act) federal privacy rules, the insured or his
or her designated representative is required to complete the claim form and
sign an authorization for release of information. The information about a claim
is considered confidential. Additional pages can be attached if more space is
needed to fully describe the condition and care needs. The claim form must be
signed by the insured or by a legally designated representative (such as
someone who has been granted power of attorney or guardianship) for that
individual. Your employee's representative must provide a copy of the
appropriate legal papers that verify the ability to legally represent the
employee or the disabled claimant.
Back to top
Q: Where does my employee send the completed claim form?
A: After reviewing the claim form completely, your employee should
sign and mail the form to:
Unum
Long Term Care Benefits Center
2211 Congress St.
Portland, ME 04122-2300
Back to top
Q: Who will review the claim?
A: After we receive the claim form, our Benefits Center will assign a long term
care benefit specialist to review all information relevant to the claim. The
benefit specialist is a trained professional with in-depth knowledge of long
term care issues. If, after reviewing the claim form, the benefit specialist
determines that additional information or clarification is needed, he or she
will call your employee or their representative to clarify information. The
final claim decision may also include input from our in-house medical staff.
Our medical staff consists of on-site physicians and nurses who interpret and
clarify medical conditions, reports and tests. This input enables the benefit
specialist to make informed decisions about medically complex claims.
Back to top
Q: What other information may be requested from my
employee during the claim process?
A: Once we receive a signed claim form we will request supporting documentation
to make an accurate determination of his or her eligibility for benefits. The
following information or activities may be requested:
- Physician and hospital records
- Home health care agency or facility notes
- Caregiver records or interview by telephone
- A face-to-face functional assessment meeting with an independent medical
professional to determine the ability of the patient to perform activities of
daily living or to clarify the extent or existence of cognitive impairment
- Written plan of care by the claimant's licensed health care practitioner (as
required by federal government on tax-qualified plans)
- Certification by a licensed health care practitioner that the disability is
expected to last a minimum of 90 days (as required by federal government on
tax-qualified plans)
Back to top
Q: Once my employee files a claim, how quickly can he or
she expect a written reply?
A: Once we receive a claim, we will send your employee or his or her
representative a written acknowledgement within three business days. The
benefits specialist will send a letter reviewing the status of the claim to
your employee every 21 days. The process of evaluating a claim, including
requesting and reviewing any additional information that may be needed, takes
approximately four to six weeks from the time we receive a completed claim form
to the final claim determination. Of course, each claim is unique and the time
frame for a determination may vary. Once a claim decision is made, the benefit
specialist will call your employee or his or her representative within one
business day and will follow up with a clearly written explanation of the basis
for the decision.
Back to top
Q: Does Unum offer resources that can help my
employee's family deal with long term care issues?
A: Yes. We offer LTC Connect, a voluntary and confidential counseling and
referral service your employee can use to address long term care concerns at no
additional cost. We contract with LifePlans Inc. to provide this program. It is
different from many other long term care assistance programs because it does
not require your employee to use a particular provider or service. In addition,
this service is available as soon as your employee's policy is effective; your
employee doesn't have to wait until he or she is out on claim to utilize the
services. Your employee can often get nationwide discount rates through LTC
Connect on participating skilled nursing facilities, assisted living
facilities, home care providers, adult day care facilities and hospice
providers. Access to discounts on durable medical equipment such as
wheelchairs, grab bars or ramps may also be available.
Back to top
Q: How can I access the counseling services of LTC
Connect?
A: Individuals can get answers to questions about long term care by calling
888-868-6745, LifePlans Inc.'s care coordinators are available Monday through
Friday from 8 a.m. - 8 p.m. EST. During off-hours and holidays, you can leave a
voicemail message that will be returned within one business day. Care
coordinators will listen, provide objective information and help callers
explore options about a variety of topics including aging, home care, Medicare
and Medicaid provisions, safety checks and the demands of caregiving.
Back to top
Q: If my employee has a question or concern about the
status of a claim or the claim process, where can he or she go for assistance?
A: If your employee has questions regarding a claim, he or she can
call our Benefits Center during regular business hours at 800-693-4988. We are
committed to responding to any questions within the following timeframes:
- If we receive an inquiry before 3 p.m. (EST), we will respond the same day.
- If you or your employee contacts us after 3 p.m. (EST), we will respond the
next business morning before 10 a.m. in your time zone.
Back to top
Q: If my employee disagrees with the claim decision,
what can he or she do to appeal?
A: If an employee is not satisfied with the claim decision, he or she can ask
to have the claim reviewed by an independent appeals unit within our company.
The request must be in writing and should include all supporting materials or
information that will help us review the claim. We will review the appeal and
all new information, and will notify the employee of our decision within 60
days of receiving the appeal. If special circumstances require additional time
for processing, the employee will be notified of the reasons for the delay. In
this case, a decision will be made within 120 days following our receipt of the
request for review. The final decision on the appeal, including the reasons for
the decision, will be communicated to the employee in writing.
Back to top
|