This document describes the process, including required forms, for filing a long-term disability claim.
Employees on New York State Disability are monitored on an on-going basis by central office and First Reliance Standard Life Insurance (First Reliance) to determine the potential for, and the employee's eligibility for, long-term disability benefits (disability exceeding six months).
The process for filing a long-term disability claim contains the following steps:
After an employee has been disabled for four months, central office sends a letter and First Reliance Benefits Application to the employee. Operating locations will receive a copy of correspondence sent to the employee.
The letter contains the following information:
The application contains the following:
Note: If an employee who is expected to be disabled beyond six months has not received this information by the fourth month of a disability, the operating location should contact the benefits administration unit in the Office of Human Resources at central office to ensure the employee receives the required documents.
The following table describes the steps taken by the employee and his or her attending physician to complete and submit all required forms.
Step |
Who Does It |
Action |
1 |
Employee |
Completes and signs the Employee Statement, Benefits from Other Sources, Authorization for Release of Information, and Repayment Understanding Agreement. |
2 |
Employee |
Submits the application to his or her attending physician and asks the physician to complete and sign the Attending Physician's Statement. Note: First Reliance may request an independent medical examination at no cost to the employee. |
3 |
Physician |
Completes the form and sends it to First Reliance. |
4 |
First Reliance |
Notifies the benefits administration unit in the Office of Human Resources at central office when the completed forms are received. |
The Employer’s Statement provides proof of the employee’s eligibility for long-term disability insurance, salary information, and a description of any other disability benefits available to the employee.
Once First Reliance notifies central office that an application has been received and central office has obtained the employee's job description from the operating location, an original, completed Employer's Statement and a copy of the job description are submitted to First Reliance.
First Reliance reviews the claim and provides the employee with written claim approval or disapproval within 105 days from the day the application was submitted. If the claim is approved, a check is sent to the employee by First Reliance each month while the disability continues.
First Reliance will estimate the employee's Social Security disability benefits and reduce the long-term disability benefits by that amount, until a written notice of benefits is received from the Social Security Administration.
Note: First Reliance and Social Security claim reviews are performed independently from one another in establishing the eligibility for disability benefits.
Refer to Benefits Provided Under Long-Term Disability Insurance for information about Social Security waiting periods and obtaining the benefits.
A medical review of each case is performed at intervals appropriate to the nature of the disability (i.e., three months, six months, or annually). During the medical review, First Reliance requests that the physician send copies of the employee's medical records that provide proof of continuing total disability.
If the claim is denied, First Reliance 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 First Reliance.
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