Other Disability Benefits The LTD program, together with any other disability benefits, is designed to provide the employee with adequate replacement income. Therefore, the LTD benefit will be reduced by other income received by the employee, including Social Security, Workers Compensation, Sick Leave, Salary Continuance, any Public Employee Retirement System Plan, or any State Teachers' Retirement System Plan or vacation.

Example:
Monthly Salary $1,200 per month
Gross Monthly Benefit $1,200 X 55% = $660 per month
LTD Benefit Calculation Gross Monthly Benefit $660
Less Workers Compensation -300
Net Monthly Benefit $360.00

When it is apparent that the employee is entitled to any of these benefits, he or she should make prompt application for them. Please call Unum to discuss any questions you may have.

If it is likely that the employee's disability will last for 12 full calendar months or more, the policy requires that the employee file for Social Security Disability Benefits, if eligible. Unum's Claim Department will provide detailed instructions regarding Social Security filing procedures.

The policy also requires that the employee file for all other disability benefits for which the employee is entitled.

Unum may request specific information by correspondence or personal contact with the GIC Coordinator, the disabled employee, or the employee's attending physician. Unum will send the GIC copies of correspondence that is sent to the employee regarding benefit approval, pending claim notification and claim closures.

Waiver of Premium Once Unum begins benefit payments, premium payments will stop. When the employee returns to work, premium payments resume. The GIC must be notified when an employee returns to work.

Appeal Procedures Claim decisions, including denials or termination of benefits, will be communicated directly to the claimant. The GIC will also receive notice of denial. Appeals of claim decisions must be made in writing within 180 days of the date the decision was communicated to the employee (the date of the denial letter).

Appeals should be submitted to the Claim Department address shown in the Appeal Process section of the claim denial letter.

APPEALS SHOULD INCLUDE THE FOLLOWING:

  • reason(s) for requesting the appeal; and
  • additional documentation in support of the request. This includes objective medical information relevant to the issues and time period surrounding the claim.

The appeal decision will be communicated directly to the person requesting the review. The GIC will also be notified of the decision.


This information provided by the Group Insurance Commission .