BY BETTY MABERRY, JORDAN SMITH, AND ASHLEY TAPP
THE HELPDESK TEAM
Many employers offer attractive benefits to their employees which can drive enthusiasm and participation, thus creating a unique position for your company to be set apart from competitors. Employees often feel valued when given the opportunity to elect coverage from a strategically planned and robust benefit package. Medical, Dental, Vision, Life/Accidental Death & Dismemberment (AD&D) as well as supplemental coverage are some of the most common plans offered by employer groups. Two other valuable lines of coverage that groups may offer to eligible employees are Short-Term Disability (STD) and Long-Term Disability (LTD).
Our HelpDesk team has found that when employers and members understand their STD and LTD plan details and have familiarized themselves with the claim process, the full benefits of Disability coverage can be appreciated. Two Disability plan details to be aware of are the elimination period and the Disability benefit amount. The elimination period is a waiting period a member must satisfy from the date of disability to the date benefits begin paying. For example, some STD plans may have a fourteen-day elimination period where benefits begin paying on the fifteenth day. A common Disability benefit amount seen on STD plans may be 60% of earnings with a maximum benefit amount. It is important to review your STD and LTD plan documents to familiarize yourself with your specific plan details.
When a member experiences a disability such as an illness, injury, or pregnancy, the member must complete and submit a Disability Claim Form either on paper or online. This form comes from the Disability insurance carrier and includes a section for the employer, employee, and physician to separately complete. The processing time of a Disability claim may depend on when the claim was received and if the insurance carrier requires any supporting medical information. Once a claim with all three sections has been submitted, the claim is assigned to a Claims Examiner or Case Manager. This person will examine and review the claim details and contact the claimant and/or physician directly with any questions or for any supporting medical documentation. Once the claim has processed, the Claims Examiner or Case Manager will contact the claimant directly by phone, email, or mail with the determination.
Though the Claims Examiner or Case Manager should be proactively in communication with the claimant throughout the claims review process, it is also beneficial for the claimant to follow up with the insurance carrier directly to be aware of the status. This allows claimants to stay on top of their claim’s processing, make sure the insurance carrier is not waiting on medical records from the physician, and to ensure their claim is processed in a timely manner.
Though the expectation when an employee becomes disabled and submits a STD or LTD claim is that they will return to work, there are unfortunately instances where the claimant passes away before benefits are fully paid out. With this in mind, it is always a good idea for employers to keep an internal record of their employees’ listed beneficiaries regardless of whether or not a Life/AD&D plan is included in the benefit package. Having a beneficiary on file allows the claimant’s Disability benefit to still be easily paid out for the approved length of time.
Though both employers and members have the ability to submit Disability claims and follow up with the insurance carrier directly, our HelpDesk is always available and happy to assist in any way.