Short-term Disability: Claims Process

Process

The Short-Term Disability claims process consists of the following steps:

Notification of Illness or Injury

An employee must notify his or her supervisor or the human resources office of an off-the-job injury or illness in order to receive New York State Disability Benefits Law (DBL) and/or Voluntary Short-Term Disability (VSTD) benefits.

The operating location will verify the employee’s eligibility status (for DBL) and/or enrollment status (for VSTD) and check his or her sick leave accrual status.

Charging Sick Leave Accruals

Operating locations must charge a disabled employee’s sick leave accruals as follows, once a determination of leave availability has been made:

If the employee...

then...

has sick leave accruals

charge sick leave accruals until they are exhausted. Provide the employee with required forms at the appropriate time. Refer to the "Required Forms" section in this document.

does not have sick leave accruals

provide the employee with required forms when the disability exceeds seven days.

Refer to "Short-Term Disability and Use of Other Types of Leave" for more detailed information on using leave.

Required Forms

The following forms must be sent to employees at the beginning of their disability

When to Send the Forms

If the employee has sick leave, the forms must be sent once the disability exceeds two weeks. If the employee does not have sick leave, the forms must be sent when the disability exceeds seven days.

Forms can be downloaded by clicking the "PDF" links above.

The following sections provide detailed information on each of the forms.

Statement of Rights

A "Statement of Rights" (DB-271S) that provides information on an employee’s entitlement to disability benefits must be sent to an employee at the start of a disability along with the disability claim form.

Notice and Proof of Claim

A "Notice and Proof of Claim for Disability Benefits" (DB-450) form includes our policy number on Part B of the form. For New York DBL claims, the policy number is 811738-001. For non-New York claims, the policy number is 811737-002.

Transmittal Memorandum

A memorandum that can be used to transmit the forms has been provided above. Two versions of the memorandum are provided:

When Claim Form Must Be Filed

The "Statement of Rights" indicates that a claim form must be filed within 30 days (but not more than 26 weeks) from the date the disability begins.

Completing and Submitting Forms

The following table shows the steps that are taken after an employee receives the disability claim forms from the operating location:

Step

Who Does It

Action

1

Employee

Completes and signs Part A, Claimant’s Statement, of form DB-450, and the Authorization for Release Form and submits the form to his or her health care provider.

2

Health Care Provider

Completes and signs Part B of form DB-450, Health Care Provider’s Statement, and returns the form to the employee or the operating location office responsible for administering NYS Disability benefits. This serves as a certification of the disability.
If the employee has VSTD, completes and signs the Attending Physician's Statement.

3

Employee

If the form has not been returned to the operating location by the health care provider, submits completed claim form (DB-450) to the operating location office responsible for administering NYS Disability benefits.

4

Operating Location

Conducts the following review:

  • Verify employee’s eligibility for DBL coverage.
  • Verify employee's enrollment in VSTD coverage.
  • Verify that the disability claim form is accurate and complete.
  • Complete Employer's Statement (Part B) on DB-450.

5

Operating Location

Mails, e-mails or faxes the DB-450 form to:

Sun Life Assurance Company

Group STD Claims
PO Box 81915
Wellsley Hills, MA 02481
Fax: (781-304-5599)

std.rcc8@sunlife.com

 

Policy #811738-001 (NY-DBL), #811737-002 (Non-NY), and #811737-001 (if the employee is also covered for VSTD)

 

Note: If the forms are faxed or e-mailed, do not send a hardcopy to the carrier.

6

Sun Life

Tracks Short Term Disability Claims for potential continuation into long-term status.

7

Operating Location

Sends a copy of the DB-450 form to RF Central Office of Human Resources, Benefits Services Unit. Central office will ensure that Oracle records reflect benefits continuation if the employee is eligible.

Payment

Sun Life reviews the claim and makes the disability determination. If the claim is approved, Sun Life will send a disability check to the employee within 2 weeks of claim submittal.

Monitoring Claims

The RF Central Office of Human Resources, Benefits Services Unit, is responsible for monitoring claims to ensure that Sun Life processes the claim and provides payment to the employee.

Additional Information Requirement

Sun Life may request additional medical records or an independent medical examination at no cost to the employee if there is unclear or conflicting medical information or if Sun Life feels the length of the disability is inconsistent with the diagnosis. A medical practitioner certified by the Workers' Compensation Board and working in the employee's home area is selected by an outside agency. The agency will make any necessary arrangements with the medical practitioner. Sun Life may also request payroll records to verify earnings and VSTD coverage.

Determining Claim Status

Sun Life may be contacted at 800-247-6875 or std.rcc8@sunlife.com to determine the status of a New York State Disability Benefits Law (DBL) claim, the status of a Voluntary Short-Term Disability (VSTD) claim, or to obtain additional information.

When a Claim is Denied

If the claim is denied, Sun Life notifies the:

Note: Long-term disability claims can be initially approved, and subsequently denied, during any of the claim's periodic reviews.

The employee has the right to appeal if denied. Instructions for appealing are included in the denial letter sent from Sun Life.

How to Obtain Forms

Forms can be obtained by clicking the links below:

Change History

 

 

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