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Q. How does an employee file a claim?
To notify us of a Voluntary Benefits Accident claim, you will need to submit a claim and any needed medical documentation to provide proof of claim. Supporting medical documentation is usually medical invoices or Explanation of Benefits. You may call our toll free number 1-800-635-5597 to request a claim form or you can click on the link below which will direct you to a location on our website where you can download and print your claim form. Once you have clicked on the link below, select:
- Claim forms
- State in which your policy was issued (usually the state you signed your application in); and
- Product you are filing a claim on
http://w3.unum.com/fmtw/employer/CategoryState.aspx?strLOB=VISTD&Title=View,%20Print,%20Order&strIsWizard=true
The claim form includes everything you will need for a claim request, including:
- Information you will need to complete
- Information your physician will complete
- An authorization form that will enable us to gather additional information as it becomes necessary.
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Q. What information needs to be submitted with your accident claim forms?
You will need to submit medical information/invoices such as:
- Emergency Room Bills
- Hospital Bills
- Ambulance Bills
- Post Operative Reports, etc
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Q. Are sicknesses covered by my accident policy?
Sicknesses can be covered on your accident policy if the sickness/hospital confinement rider or the disability income rider is elected. Proof of hospitalization will need to be submitted (i.e. Hospital bills) for eligibility under the sickness hospital confinement rider. An attending physician must certify disability by completing an Attending Physician's Statement to be eligible for the disability income rider. Both riders are subject to pre-existing condition reviews.
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Q. Who will review the claim?
Once we receive a claim request (including all four parts mentioned above), you will be provided with direct access to a voluntary benefit specialist (VBS) who will personally handle your needs. The VBS, an individual trained in specific types of accident coverage, will evaluate the information provided, and will arrange payment of the financial benefits for which you are eligible.
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Q. Is anyone else involved in the review process?
When appropriate, the voluntary benefit specialist will call or send a medical records request to your attending physician to ask for additional information needed for review. Our physicians, nurses, case managers and vocational rehabilitation consultants support our voluntary 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, if appropriate.
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Q. When will an employee know about his/her benefits?
For most voluntary benefits (VB) claims, payment decisions can be made within five business days of Unum's receipt of the completed claim. If the medical condition is more complicated, however, an accident claim review may take up to 30 days. If we need additional information, and therefore require more time to make a claim decision, we will provide you with a written update on the claim status at a minimum of every 30 days until a decision is reached. 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.
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Q. What if the employee has questions about a claim?
Throughout the claim review process, you will be kept up-to-date through letters. Phone calls will be made if needed. Our claims call centers are staffed from 8 a.m. - 8 p.m. EST. Interactive voice response information is available 24/7.
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Q. What happens if the employee disagrees with Unum's decision on a claim?
Our claims process is designed to ensure that your claim receives a 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, you 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.
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Q. What should the employee do if he/she does not receive the benefit check?
Our call center is open from 8:00 a.m. until 8:00 p.m. Eastern Standard Time. You may call 1-800-635-5597 and inquire about the check status. If the address is correct, please allow 10 business days from the date of issue for the check to be delivered. If a check is inadvertently mailed to the wrong address, the check will be canceled and reissued immediately.
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Q. Is the employee's benefits taxable?
Your benefits are not taxable. The policy premiums are deducted from your paycheck after taxes have been deducted; therefore, the benefits cannot be taxed.
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