Filing Claims

Filing Claims

If you are receiving benefits under the voluntary Short Term Disability (STD) Plan and your disability is expected to continue beyond 52 weeks, Lincoln Financial will automatically contact you and request that you complete any additional forms and/or provide necessary information to process your long term disability claim.

If you are not enrolled in the STD Plan and are eligible for long term disability benefits, you will need to contact the Benefits Department for long term disability plan claim forms as soon as you believe your disability will last longer than 52 weeks.

As part of the claims filing process, you will be asked to complete a claim form to show proof of loss. The claim form is available from the Benefits Department, or you can request a claim form from the plan administrator. If you do not receive the form from Lincoln Financial within 15 days of your request, send Lincoln Financial written proof of the claim without waiting for the form (written proof includes the occurrence, character, and extent of the loss.

You and the Company must fill out your own section of the claim form, then your doctor should fill out his or her section of the form and send it directly to Lincoln Financial.

You should notify the plan administrator of your claim as soon as possible, so that a claim decision can be made in a timely manner. You must send the plan administrator written proof of your claim no later than 90 days after the 52-week elimination period. If it is not possible to give proof within 90 days, it must be given no later than one year after the time proof is otherwise required, unless you are not legally capable.

Claim Determination

After receiving all the necessary information (employee's statement, attending physician's certification of disability, additional documentation, employer verification, etc.), the claims administrator will determine if your disability claim qualifies for benefits under the plan.

The claims administrator will send you a written notice of the claim determination within 45 days of the receipt of your claim. This time period may be extended for two additional 30-day periods, up to a maximum of 105 days for matters beyond the claims administrator's control.

If the first 30-day extension is necessary, you will receive written notice of the extension within the original 45-day timeframe. If a second 30-day extension is necessary, you will receive written notice before the first extension period is over. All notices will explain why an extension will be necessary.

Ongoing Proof of Claim

Lincoln Financial may request that you provide satisfactory proof of continuing disability, indicating that you are under the regular care of a doctor. This proof, provided at your expense, must be received within 90 days of a request by Lincoln Financial.

In some cases, you will be required to give the plan administrator authorization to obtain additional medical information, and to provide non-medical information as part of your proof of claim, or proof of continuing disability. The plan administrator will deny your claim or stop sending you payments if the required information is not submitted. 

You must notify the plan administrator immediately when you return to work in any capacity.

When Payments Are Made

If approved, the claims administrator will calculate the amount of your benefit payment and send a check to your home. Benefit checks will be issued at least once a month at the end of each month of continued disability, provided your claim has been approved and is complete in all respects at that time.

Benefits are paid monthly. If the beginning or ending of a disability period is a partial month, your benefit for that month will be prorated. The amount of benefit payable will be 1/30th of the monthly benefit per day of the partial month.

If Your Claim Is Denied

If your claim is denied, the claims administrator will send you a written notice of denial which will include:

• The specific reasons for the denial
• Reference to the specific plan provision on which the denial is based
• A description of any additional material or information necessary for you to complete your claim and an explanation of why such material or information is necessary
• Steps required for you to appeal the decision
• If the decision is based on medical necessity or experimental treatment, an explanation of the scientific or clinical judgment will be provided free of charge upon request

If you disagree with the claim decision, or if you did not receive a response within the timeframe, you have the right to request a thorough review of the decision. If you do not request an appeal in writing on time, you will lose your right to appeal your denial or to file a suit in court. The procedure is as follows:

• If your claim for benefits is denied or if you do not receive a response to your claim within the appropriate timeframe (in which case the claim for benefits is deemed to have been denied), you may appeal your denied claim in writing within 180 days of the receipt of the written notice of denial or 180 days from the date such claim is deemed denied. You may submit with your appeal any written comments, documents, records and any other information relating to your claim. Upon your request, you will also have access to, and the right to obtain copies of, all documents, records and information relevant to your claim free of charge.
• After receipt of your written review request, a full review of the information in the claim file and any new information submitted to support the appeal will be conducted by individuals not involved in the initial benefit determination. This review will not give any deference to the initial benefit determination. The plan administrator will notify you in writing about its final decision within 45 days of your appeal (or within 90 days if an extension is needed).
• If the claim on appeal is denied in whole or in part, you will receive a written notification from the plan administrator of the denial. The notice will include:
  • The specific reason(s) for the adverse determination
  • References to the specific plan provisions on which the determination was based
  • A statement that you are entitled to receive upon request and free of charge reasonable access to, and make copies of, all records, documents and other information relevant to your benefit claim upon request
  • A description of the claim administrator's review procedures and applicable time limits
  • A statement that you have the right to obtain upon request and free of charge, a copy of internal rules or guidelines relied upon in making this determination
  • A statement describing any appeals procedures offered by the plan, and your right to bring a civil suit under ERISA
• If the claim on appeal is denied, you may make a second, voluntary appeal of your denial in writing to the plan administrator within 180 days. The procedure is the same as for the first appeal.