If the claim is found to be appropriate for Early Intervention, a Disability Specialist and Nurse Case Manager will immediately begin processing of the claim.

Filing a Claim
When an employee's disability (including disabilities caused by occupation related sickness or injury) is likely to continue beyond the 90-day elimination period, the following steps should be followed:

1) Approximately 45 days before the end of the elimination period, the employee should call Unum using the dedicated toll free number 1-877-226-8620 option 1 to request a claim submission packet.

Unum will send the employee a claim submission packet within one business day. The packet will contain:

2) The employee should:
a) Give the Employment Statement to the GIC Coordinator to complete and return to the employee.
b) Give the Attending Physician Statement to the Physician to complete and return to the employee.
c) Complete the Claimant Statement.
d) Return the Employment Statement, the Claimant Statement, and the Attending Physician Statement to Unum fy faxing to 800-447-2498 or mailing to the address on the forms within 14 days.

Claim Processing
Initial Claim Processing. When Unum receives the LTD Claim Forms, they will assign a claim number and advise the employee of that number.

To qualify for benefits, an insured employee must:
1) be disabled during the 90-day elimination period and beyond in accordance with the policy provisions; and
2) meet all eligibility requirements as outlined in the policy.

In addition, premium for the coverage provided under the policy must be paid to date.

Once the 90-day elimination period ends, claim payments are made in accordance with the policy provisions. Claim payments will be sent directly to the claimant unless otherwise specified.

If additional information is needed to make the initial evaluation of the claim, Unum will contact the GIC Coordinator, the employee, or the employee's physician to obtain this information.

After benefits begin, additional medical information will be necessary to support continued disability and to verify that the employee is under the appropriate regular care and attendance of a physician. The employee's condition and the physician's prognosis determine how frequently this information is needed.

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 $1200 per month
Gross Monthly Benefit $1200 X 50% = $600 per month
LTD Benefit Calculation Gross Monthly Benefit $600.00
Less Workers Compensation -300.00
Net Monthly Benefit $300.00

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.