Disability Claims Guide

Our promise

Delivering on our promise means a lot to us at USAble Life. Whether it’s an accident, an illness, or another life-changing event, we value our commitment to process and pay claims according to our insurance policies with the greatest care and integrity. You can feel secure in knowing that when you buy insurance from USAble Life, that’s exactly what you will get. It’s our assurance — our pledge — that we will be there for you.

Submitting a claim

Complete the forms located in the claims download and submit to USAble Life in one of the following ways:

Short Term Disability

Temporary Disability Insurance

In addition to claim forms for each product, the following other documents are required for a complete claim for Short Term Disability (STD) or Temporary Disability Insurance (TDI). Some of these forms will be the employer’s responsibility to complete; others will be the employee’s responsibility to complete.

  • Employee or claimant’s statement
  • Authorization for release of medical records
  • Fraud notice
  • Employer statement
  • Attending physician or doctor’s statement

See the claims submission checklist on the claim form to make sure the claim is complete.

Long Term Disability

Because Long Term Disability (LTD) claim forms can vary based on the policy terms, LTD claim forms are available by contacting Customer Care at (800) 370-5856.

Short Term Disability or Temporary Disability Insurance transition to Long Term Disability

If an employee has both STD and LTD or TDI and LTD coverage with USAble Life, and an STD or TDI claim is approved for the maximum benefit duration provided by the policy, we will refer the STD or TDI claim for LTD eligibility review. The LTD team will review the claim and notify the employee of any additional information needed to complete the review. It is not necessary for the employee to submit a separate LTD claim form.

Claim decisions

A decision to pay, pend,* or deny a claim is reached on 95% of all claim submissions within five business days of receipt of claim. Factors that increase claims processing time

  • Medical record(s) request(s)
  • Premium status
  • Clarification of eligibility
  • Earnings/payroll information

Claim payments

Payments are made to the employee once an approval decision has been made and the employee has reached the benefit start date. STD and TDI benefits are paid weekly and LTD benefits are paid monthly. These payments will continue if the employee continues to meet the policy definition of disability but not beyond the maximum benefit period provided by the policy. The benefit will be reduced by other income benefits dependent on the policy. Additionally, taxes can be withheld based on premium contribution methods and employee elections.

Appeals

Appeals must be submitted in writing within 180 days of the claim decision.

Although not required, claimants may use the appeal form located in the claims download for a STD appeal.

For any adverse claim decision, a letter with a detailed explanation of the determination will be provided. This will include specific instructions on how to appeal the decision if you do not agree with the findings, and where to send your appeal.

The appeal will include a new, comprehensive review of all documents and a determination by an individual who did not make the first claim decision.

Appeal decisions are made within 45-60 days.

*Pended claim: If the examiner needs information from an outside source (e.g., medical provider, employer), the information will be requested, and the claim will be put in a pended status for up to 45 days until the information is received. The response time for medical record(s) requests varies and may require an extension of the pended status.