Action Plans
This field in the action plan should address other income benefits that EE is receiving or may be eligible to receive, including DCNs and dollar amounts for any confirmed sources of other income, denial letters, or status information as well as the date of the most recent B&O interview.
What is Offset Development?
When you approve a claim before you're given dollar authority, you complete this referral.
What is a referral to Claim Support Specialist (CSS)?
This is the tool utilized to calculate key ERISA dates as well as the Proof of Loss date.
What is the ERISA & Proof of Disability Calculation Tool?
This information can be located in the Job Aids tab of the LTD Participant Workbook, and can be utilized to identify commonly used letter templates?
What is CCT Template ID?
EE
What is Employee?
This field should contain on overview of job demands, EE's motivation level for RTW, the need for any additional evaluation to assess functionality, and any RTW incentives applicable.
What is Return to Work Potential?
The only situations in which we would terminate a claim retroactively.
What are full duty return to work or claimant's death in the past?
This provision sets forth a timeframe during which coverage can be contested with the medical underwriting unit if it is found that information provided on the Statement of Health application was incomplete or inaccurate. The standard timeframe is 2 years. If beyond this timeframe as of DDC, no investigation is needed.
What is Incontestability: Statements Made by You?
This letter acknowledges receipt of an LTD claim, requests forms and medical information needed for Proof of Disability.
What is the LTD Acknowledgement Letter (template ID 933)?
DDC
What is Date Disability Commenced?
This portion of the action plan should contain a brief overview of the reason the claimant went out of work, medical history, and current status including restrictions and limitations, as well as an assessment.
What is Medical Development?
This is the timeframe in which a decision has to be made upon receipt of all pertinent medical and vocational information.
What are 5 business days?
Separate evaluations need to be completed for both core and buy up coverage to determine whether an investigation is needed under these provisions.
What are Evidence of Insurability and Pre-existing Conditions?
This letter contains information including relevant plan provisions, benefit calculation details, taxability, other income, payment information, maximum and minimum benefit information
What is LTD Initial Approval No RTW (template ID 925)?
LDB
What is Limited Disability Benefit?
This field should include information such as EE's email, alternate phone numbers, HCPs names, specialties and contact information including phone and fax information, attorney or non-attorney representative name, DCN where letters of representation is located and contact information, etc.
What is Key Contacts?
This is based on several factors including the outcome of an eligibility review, definition of disability, the claimant's clinically validated functionality, and the outcome of any relevant vocational review.
What is Initial Claim Decision?
These two criteria must be met in order for Evidence of Insurability to be a requirement of a Plan?
What are Fully Insured and Contributory?
The process of verifying accuracy and appropriateness of all letters prior to their release, to include demographic information, dates and dollar amounts, clear content, avoiding technical wording and acronyms, and that spelling, grammar and formatting are correct.
What is proofreading?
OOW
What is Out of Work?
This field should include what information was requested, who it was requested from and the due date for the requested information.
What is Outstanding Information?
This is the timeframe in which decision notification, both written and telephonic, has to be completed after a decision is finalized.
What is 24 hours?
This is the time period under the Filing a Claim section of the Plan that defines the period allowable for the claimant to submit proof.
What is Proof of Loss/Proof of Disability?
One of these two letters should be sent if a decision can't be completed between the 35th and 45th day of receipt of a claim governed under ERISA.
What are Extension with Tolling (1137) or Extension without Tolling (1131)?
IPC
What is Independent Physician Consultant?