Disability – Vice President and Above
 

Filing Your Claim 

This section describes the procedures for filing Long-Term Disability (LTD) Plan claims. It is your responsibility to file a claim as soon as reasonably possible after the onset of your disability.

CLAIM FILING PROCEDURE
The procedure for filing LTD Plan claims is as follows: 

To file a claim, you can:

  1. complete an online claim form at www.unum.com/claims, click on Download a Form to search for the appropriate form and follow the online instructions;
  2. call Unum at 1-866-779-1054 (available 24 hours a day, 7 days a week); or
  3. provide written notice and send to:

Unum Life Insurance Company of America
2211 Congress Street
Portland, Maine 04122
Phone Number: 1-866-779-1054

Please make sure you can provide Unum with: 

    • your name and address, phone number, birth date, social security number and e-mail address;
    • your employer’s name (Tufts Associated Health Plans, Inc.);
    • the policy number (LTD Plan: 425544 012);
    • employment information such as date hired and job title;
    • the reason for your claim – illness, injury, or pregnancy;
    • a description of your illness, symptoms, and/or diagnosis. Include the date the symptoms first appeared and if you have ad these symptoms before;
    • the extent of your disability, including restrictions and limitatiosn preventing you from performing your job;
    • information about any workers' compensation claims you have filed or plan to file;
    • details about all doctor, hospital or clinic visits, including dates and contact information; and
    • appropriate documentation of your monthly earnings.

If you call to report your claim, Unum will ask you for your permission to get your medical information. You can give this permission during the call, which will help to process your claim more quickly.

After you finish giving your claim information, the phone agent will transfer you to a recorded message. Listen to the recording and answer “yes” or “no” to the questions. At the end of the recording, say “yes” if you give permission or “no” if you do not. 

After your call, Unum will send you a letter which will include a copy of the recorded message for your records. The letter will include a form for you to sign and return to Unum. Check with your doctor to see if he or she has any other forms you may need to sign to give permission to release medical records. 

A Unum claim manager will call you and your employer for a list of your job requirements. The claim manager will call your doctor for your medical records. This information will help Unum determine how long you may be out of work and the benefits you may be able to receive. 

PROOF OF LOSS
You must provide Unum with written proof of your loss no later than 90 days after your elimination period, but not later than one year after that date.

Physical Examination
The Insurance Company may require that you undergo a physical examination within the 45-day period following the date that it receives your claim. This examination will be at the Insurance Company’s expense. During this 45-day period, the Insurance Company may also require that you provide any additional relevant information concerning your claim. 

CONTINUING DISABILITY
The Insurance Company may request that you provide proof of your continuing disability (i.e., after your initial claim has been approved). This proof must be received within 30 days of the Insurance Company’s request. 

The Insurance Company may request your permission to obtain additional information to support your claim. If you deny this request (or if the information is not provided), the Insurance Company may deny your claim or terminate your disability benefit payments.

BENEFIT PAYMENT ADJUSTMENTS
Any overpayments or amounts paid in error with respect to LTD Plan coverage must be reimbursed by the recipient for the overpayment or amount paid in error. 

DENIED CLAIMS
You or your beneficiary can appeal a denied claim. The claim appeal procedures are described in the Administrative Information section of this Summary Plan Description (SPD).