When all information from all parties is received by Dearborn, they will begin evaluation of the claim. This form requires completion by the employee, the employer and attending physician or physicians. How would an insured access their benefits? Prior to delivering the baby, the mother should start completion of the Group Short-Term Disability Claim form. Short term disability is a great product for female employees of child bearing age. Cesarean births qualify for 8 weeks after their elected waiting period. For a natural birth, women can receive 6 weeks of disability after their elected waiting period. Maternity is an illness that is considered to create a disability so women who have given birth qualify for disability benefits. If offering long term disability as well, you would match the short term duration with the waiting period for the long term policy. The duration for the short term disability can be 13 or 26 weeks.
Short term disability provides income protection when an insured is physician certified to be disabled. If there is still no determination of the WOP (wavier of premium) claim review by that time, they must drop the member off the coverage and offer conversion and/or portability, if they are eligible. Please note: to be eligible for Waiver of Premium review the member must be truly disabled and the premiums MUST be paid on the coverage for 12 months from the date of disability. Dearborn reviews the claim and determines if the member is eligible. After 9 months, the physician can then determine if the disability is resolved, temporary or permanent.Ībout 9 months into a disability, the member should file for a waiver of premium claim. Permanent disability cannot be determined until the member has been under a physician’s care and treatment for 9 months. Upon initial determination that an insured is disabled, a physician will determine if the disability is total or partial and it will initially be considered temporary. After one year, the benefit reduces to the benefit percentage less any income from other sources. This benefit pays up to 100% of the maximum benefit during the first year of the partial disability. Dearborn will pay partial disability benefits once the insured has met the elimination period with a combination of total and/or partial disability and is earning less than 80% of the pre-disability income.
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After benefits have been paid for 24 months, disability is then determined by the insured’s ability to perform all of the material and substantial duties of his or her own or any other occupation for which they are qualified for by training, education, experience, age and physical and mental capacity.ĭefinition of partial disability: When an employee has a disability but is able to perform one or more (but not all) of the material and substantial duties of his own occupation or any occupation on a full time or part time basis. Disability must be certified by a physician. Let’s first understand the basic terminology of this product.ĭefinition of total disability: When an employee is unable to perform the material and substantial duties of his or her occupation on a full time or part time basis, and is not receiving any earnings for work or service. It is important to understand how this product works when an employee experiences a condition that is disabling so that coverage is not terminated inappropriately or benefits are declined. Some products are portable, meaning that when the employee is no longer active, they can convert the policy to an individual product that they can keep.
Group life and disability plans offer benefits to active eligible employees only.
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However, life and disability are only used upon death or a medical condition that is disabling so how to use these products may be less familiar to employers and employees. With medical benefits, this is naturally done because these benefits are used on a regular basis.
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