What is the deadline to file a Long-Term Disability Long-term Disability claim?
The Long-term Disability claim form must be submitted to Dearborn National at the address shown on the claim form within 12 months of the date your disability began.
How do I file an Long-term Disability claim?
A completed Disability claim form is required. All claim forms require information to be provided by three parties: the insured employee, the benefits coordinator, and the attending practitioner. You must complete identifying information in the Employee's Preliminary Statement and forward the form to your benefits coordinator who will complete the Employer's Statement and return the form to you. When you receive the form, have your doctor complete the Attending Practitioner's Statement. Then, complete, sign, and date the claim form and forward with all attachments to Dearborn National at the address shown on the claim form. Dearborn National must receive the form within 12 months of the date your total disability began.
What is the appeal process if my claim is denied?
The letter you receive from Dearborn National will explain your appeal rights.You may ask for reconsideration of the decision by submitting a request in writing along with any additional information to the Dearborn National Claims Department. Any additional information submitted for reconsideration will be reviewed. If Dearborn National determines that your claim warrants a second denial, you will be notified in writing of the decision and Dearborn National will provide you with instructions for filing a grievance with ERS.
Grievances must be submitted in writing to ERS within the time stated in your denial letter. Upon receipt of your appeal, ERS will provide you with notification of receipt and obtain all information regarding your claim from Dearborn National in order to review your grievance. ERS will notify you in writing of their decision.
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When does Long-term Disability become payable?
If you are disabled, you may be eligible to receive Long-term Disability benefits after you have completed the waiting period of your sick leave, extended sick leave, and sick leave pool, or 90 consecutive days, whichever is greater. Long-term Disability benefits are issued monthly at the end of each 30 day benefit period. To check the status of your claim, contact Dearborn National Customer Service at 1 (855) 377-5433.
What is the maximum time frame I will receive Long-term Disability benefits?
Your age as of the date your disability began will determine the period for which you may be eligible to receive Long-term Disability benefits. Your age as of the date your disability begins also will determine the maximum benefit duration for receiving Long-term Disability:
- Under age 60: to age 65*
- Ages 60 to 64: 60 months
- Ages 65 to 69: to age 70*, or 12 months, whichever is greater
- Ages 70 and over: 12 months
*
The maximum benefit period for Mental and Nervous Conditions is 24 months unless you are totally disabled, under an approved practitioner's regular care, and confined in a hospital or institution specializing in the treatment you require.
Additionally, after 24 months of Long-term Disability benefit eligibility, the definition of total disability changes from performing the tasks of your own occupation to performing the tasks of any occupation for which your are reasonably qualified by training, education, or experience.
What happens if I am receiving other sources of income?
Long-term Disability benefits are reduced by other sources of income to which you may be entitled such as Short-term Disability benefits, Worker's Compensation, Employees Retirement System (ERS) or Teacher Retirement System (TRS) disability retirement benefits, Social Security Disability benefits for you and any of your eligible dependents, and other group disability benefits. This reduction is called integration with other sources of income.
The maximum Long-term Disability benefit payable is the lesser of 60% of your insured monthly salary or $6,000; and if you are approved for this coverage, your minimum Long-term Disability benefit is 10% of your insured monthly salary for up to 12 months.
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Is pregnancy or childbirth covered under my Long-term Disability coverage?
If you are disabled from any covered condition, including pregnancy or childbirth, it is considered to be an illness/sickness covered under your Long-term Disability coverage.
Is my Long-term Disability benefit taxable?
If your employing agency pays any portion of your Long-term Disability insurance premiums, that portion of Long-term Disability benefits paid are taxable for the duration of the claim.
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