Filing Claims

Filing Claims

To file short term disability claim, contact the Benefits Department at 800-421-1968.

You should initiate your claim for benefits within 30 days of the date of injury or illness or as soon as it is reasonably possible to do so. 

You must provide proof of loss to Lincoln Financial, the claim administrator, no later than 30 days after the end of the elimination period. To avoid delay, you should file your claim as soon as possible. 

  

Filing Your Claim By Phone

There are no claim forms to complete. To file a claim for short term disability benefits available under this plan, follow these steps:

• Call Lincoln Financial at 844-243-7758 and provide the Lincoln Financial Customer Service Representative with all relevant information over the telephone.

• Have your physician call Lincoln Financial at the same toll-free number to verify your disability.

  

Filing Your Claim Online

To file your claim online, visit Lincoln Financial's website. To register as a new user, enter CANON for the company code. The following steps will occur in the online process:

• You will be asked to provide the following information: your employer's name, your state of residence, and your work location.
• You will then be asked to complete and submit the online claim form.
• A confirmation page will appear which will include instructions for the next steps (i.e., call your doctor, call your supervisor, complete the forms, etc.).
• Lincoln Financial will send you a confirmation electronically reminding you of the next steps to continue the claim filing process.
• Lincoln Financial will then send you a final confirmation electronically that identifies your permanent claim number.

  

Online Services

Whether you have filed your claim over the phone or online, you can get a variety of services and information through Lincoln Financial's website such as:

• Instant access to the status of your claim, including status of received faxes and forms, your estimated return-to-work date, and special instructions for specific claims.
• Payment history and upcoming payments, dates and amounts.
• Employee and physician forms.
• Frequently asked questions (FAQs).
• Information regarding disability, laws and other resources.
• E-mail capability with Lincoln Financial's customer service representatives.

  

Processing Your Claim

The processing time for claims depends largely on how complete the initial paperwork is and, if additional information is required, how long it takes for the claims administrator to receive the required information.

In any event, Lincoln Financial must notify you within 45 days from the time it receives your claim as to whether your claim has been approved or denied or whether additional information is required. If Lincoln Financial needs more time to process your claim, the claims processing period may be extended for two additional 30-day periods, up to a maximum of 105 days.

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 outline why an extension will be necessary.

During the claims processing period and throughout the benefit payment period, Lincoln Financial may require supplemental documentation from your attending physician (or those authorized to certify disabilities as often as deemed necessary) while you are claiming benefits under this plan. The Company and Lincoln Financial have the right to have you examined or evaluated at reasonable intervals to determine your eligibility for receiving benefits. This may be done when and as often as may be reasonably required during the period payments may be due under this plan. Supplemental documentation and/or extensions of disability must be filed within 20 days of date requested or your claim may be denied.

At any time during the claims filing process or while payments may be due under this plan, the claims administrator may ask an independent third party to review your disability claim.

  

When Payments Are Made

Once your claim is complete and valid in all respects (claim form, additional documentation, employer verification, etc.), Lincoln Financial will process your claim within five working days. Lincoln Financial will issue an initial benefit check and send it to your home address. Lincoln Financial will then issue subsequent benefit checks with a detailed statement every two weeks, provided your claim continues to be approved and complete in all respects.

The plan has the right to recover any overpayment of benefits caused by, but not limited to, fraud, claim processing errors, or your receipt of other income benefits.

If your disability is someone else's fault, this plan will not pay benefits unless you or your legal representative agree to specified repayment options. 

  

If Your Claim Is Denied

If your claim is denied in whole or in part, you will be furnished with a written notice of the 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.

The steps required for filing an appeal will depend on whether you live in or outside California.

If you live outside California, your appeals process is driven by a federal law called ERISA.

You have the right to request a thorough review of the decision. If you do not request an appeal in writing within the timeframes outlined below, you will lose your right to appeal your denial or to file a suit in court.

Within 180 days after you receive written notice of the initial determination on your claim, you must file a written request for a review. The review request should include any additional facts and documentation that will support your claim. For your assistance, you may:

• Request a copy of the plan document and all of the records pertaining to your claim at no charge.
• Ask for further explanation of the pertinent plan provisions and the reason for the initial determination.

Your written request for a review must be mailed to:

Corporate Benefits Department
Canon Medical Systems USA, Inc.
2441 Michelle Drive
Tustin, CA 92780

After receipt of your written review request, Lincoln Financial will present all of the relevant information to the Corporate Benefits Department who will review and reconsider your claim. The Corporate Benefits Department will notify you in writing about its final decision within 45 days of your review request (or for 90 days if an extension is needed).

If the appeal decision supports the first denial, the decision notice will include:

• The specific reasons for the denial.
• The plan provisions on which the decisions is based.
• A statement of your right to review, on request, relevant documents and other information at no charge.
• A decision of any internal rule, guideline, or protocol used to make the decision (and provided to you at no charge upon request).
• A statement of your right to bring suit under ERISA.

If you live in California, you must send an appeal directly to the California Employment Development Department (EDD). If you disagree with the determination made on your claim, you must request an appeal in writing within 20 days of receiving your claim denial.