Life and AD&D

Filing Your Claim 

This section describes the procedures for filing claims. Your beneficiary should be aware of these procedures. 

In the event of your death, your beneficiary will need to file a claim for benefits. This also applies to you if you are the beneficiary (i.e., in the event of the death of an eligible dependent). Human Resources will be available to assist your beneficiary in determining what your coverage is and in completing the necessary forms.

BASIC AND OPTIONAL EMPLOYEE TERM LIFE INSURANCE
Upon your death or the death of another covered person, your beneficiary should contact Human Resources. Following the initial notification of death, Human Resources will send your beneficiary the necessary claim forms. 

Your beneficiary should follow the claim filing instructions shown on the claim forms. The completed forms, along with written proof of death, should be returned to the following address: 

Tufts Health Plan
Human Resources
705 Mount Auburn Street
Watertown, MA 02472 

Proof of death must cover the occurrence, character, and extent of loss. This written proof, along with the necessary claim forms, should be returned to Human Resources at the address shown above within 90 days of the date of loss, unless it is not reasonably possible to do so. In that case, the claim will not be affected if the proof is furnished as soon as reasonably possible (but not later than one year after it would otherwise be due, unless the claimant is legally incapacitated). 

BASIC AND VOLUNTARY ACCIDENTAL DEATH AND DISMEMBERMENT (AD&D) INSURANCE
You or your beneficiary should contact the Life Insurance Company of North America toll free at 1-800-732-1603 immediately if you or an eligible dependent suffers an accidental injury that qualifies for Basic or Voluntary Accidental Death and Dismemberment (AD&D) benefits. The Insurance Company's Claims Department will assist you in determining your eligibility for benefits and filing the necessary claim information. 

Claim Notice
Written notice of the claim should be provided to the Insurance Company at the address shown below within 31 days of the date of loss (or as soon as reasonably possible after that date). This notice should include the claimant’s name and the policy number (Tufts Health Plan Policy 425544 013). 

The address for providing written notice of the claim is: 

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

Claim Forms
The Insurance Company will provide you or your beneficiary with the appropriate claim forms within 15 days of its receipt of the claim notice. (If these forms are not provided within 15 days, you or your beneficiary will be considered to have met the proof of loss requirement if you or your beneficiary submits proof of loss within the time frame described below.) 

You or your beneficiary should follow the claim filing instructions shown on the claim forms. The completed forms, along with written proof of loss, should be returned to the Insurance Company at the address shown above. 

Proof of Loss
Written proof of loss must cover the occurrence, character, and extent of loss. This proof, along with the necessary claim forms, should be returned to the address shown above within 90 days of the date of loss, unless it is not reasonably possible to do so. In that case, the claim will not be affected if the proof is furnished as soon as reasonably possible (but not later than one year after it would otherwise be due, unless the claimant is legally incapacitated). 

Physical Exam or Autopsy
The Insurance Company has the right to require that a covered person undergoes a physical examination, at the Insurance Company’s expense. The Insurance Company also has the right to have an autopsy performed, unless forbidden by law. 

Legal Action
No action at law or in equity can be brought until after 60 days following the date written proof of loss was given. No action can be brought after 3 years (South Carolina, 6 years) from the date written proof is required. 

Exposure and Disappearance
If your body, or the body of an eligible dependent, has not been found within one year of the disappearance, forced landing, sinking, or wrecking of any vehicle in which you or the eligible dependent was an occupant, then it will be presumed that you or the eligible dependent suffered loss of life. 

BENEFIT PAYMENT ADJUSTMENTS
The Insurance Company has the right to recover any overpayments or amounts paid in error with respect to any Company-sponsored Life or AD&D Insurance coverage. 

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).