Long Term Disability Insurance Claim Guide

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A Complete Claim Consists of These Three Forms:

1. Employee’s Statement of Claim for Benets should be

completed by the employee.

2. Employer’s Statement of Claim for Benets should be

completed by the employer.

3. Attending Physician’s Statement form should be

completed by the physician.

Important!

The claim is considered pending until MNL receives all

three parts of the application. The insured and group will

receive correspondence advising what forms, if any, are

still missing. That means no work is able to be done on the

claim until all forms are completed and received, and the

claim is complete.

A Claim Can Be Submitted Via Mail, Fax, or Online:

Mail:

Madison National Life Insurance Company, Inc.

P.O. Box 2865

Clinton, IA 52733-2865

Fax:

608-830-2701

Online:

www.madisonlife.com

When a claim is reviewed, the

Claims Specialist evaluates

the claim application and

submitted medical records.

To expedite the claim, include

medical records from all

treatment providers. MNL

can request medical records

on the insured’s behalf but

note that this will delay the

processing of the claim. If

some but not all medical

records are released, MNL

may be required to continue

the review of the claim

with incomplete medical

information.

What About Medical Records?

How to File an LTD Claim:

LTD claim forms can be printed or completed online at www.madisonlife.com. The group may also have these forms

on hand when an insured needs to le for disability.

Long Term Disability Insurance Claim Guide

This handy guide will walk you through the entire disability Claim process, from lling out forms for Long Term

Disability (LTD) insurance to how Madison National Life Insurance Company, Inc. (MNL) makes a claim determination.

NIS Guide

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Long Term Disability Insurance Claim Guide

The claim process really begins once the claim is submitted to MNL. There is a lot that goes on behind the scenes

between the time the paperwork is submitted to the time the insured receives a determination letter.

The Claim Process:

A Claims Specialist Will Be Assigned to the Claim

Once the Claim Application Is Received and

Eligibility Is Veried. A Claims Specialist Will:

• Perform an initial claim review and request additional

documentation from the employee if needed

• Answer any questions the group or insured may have

• Assist the insured throughout the entire life of the

claim, including coordinating their return to work, and

helping them obtain benets like Social Security if

appropriate

• Make the nal claim determination – approved or

denied and provide correspondence explaining the

rationale for the determination

How Long Does It Take to Get a Claim

Determination?

Turn-around times vary, depending on information

needed for the claim. A determination is made as soon

as a complete evaluation of the claim is nalized. An

evaluation can take longer if medical records are needed

and they weren’t submitted with the initial application, a

medical review is required, etc.

How to Speed Up a Claim Review:

1. Submit the claim as early as possible.

There is no need to wait to le a claim. An application

for benets can be submitted as soon as the insured

knows that they will be unable to work (due to birth of

a child, upcoming surgery, etc.)

2. Submit medical records along with the application.

Medical records are required for many claim

determinations and it is recommended that records

be submitted along with the initial application.

INFORMATION

REQUESTED

CLAIM

DETERMINATION

MADE

DECLINE

LETTER

SENT

APPEAL

CLAIM

PROCESSING

INITIAL CLAIM

REVIEW

DEEMED

INELIGIBLE

FOR BENEFITS

DEEMED

ELIGIBLE FOR

BENEFITS

CLAIM

RECEIVED

ELIGIBILITY

VERIFIED

CLAIM

PAID

APPROVAL

LETTER

SENT

LTD CLAIM

FLOWCHART

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Long Term Disability Insurance Claim Guide

Claim status can be checked online anytime

at www.madisonlife.com.

Once the Claims Specialist makes a determination, the claim is either

approved or denied.

Filing for a Short Term Disability Insurance (STD) claim is

the same process as the LTD if both policies are with MNL.

If the STD period ends, it can be rolled into an LTD claim without any additional

paperwork. Additional paperwork would be required if your STD and LTD

coverages are with two different carriers.

LTD:

Premiums must be paid through the elimination

period. When an insured is eligible for a LTD

payment, LTD insurance premiums are waived.

Indicate on your billing statement that the

employee is on LTD and include the approved

effective date of disability.*

Group Term Life Insurance (GTL):

For those disabled insureds who have both their

GTL and LTD coverage through MNL, a GTL

Waiver of Premium claim is opened when the

LTD application is received. Premiums must

continue to be paid until the Waiver of Premium

claim is approved by MNL. For those claimants

who have their GTL through another carrier, a

separate claim would need to be led.

*Not applicable for most STD policies.

Claim Approved

If the claim has been approved, the

Claims Specialist will send out an

Approval Letter to the insured and a

copy to the group.

Benets will be paid following the

completion of the elimination period*,

and the receipt of the Reimbursement

Agreement form (if required by the

policy).

*The elimination period is a time frame

during which no benets are issued

following the start of a disability.

Claim Denied

If the claim has been denied, the

Claims Specialist will send out

Denial Letters to both the insured

and group. Both letters are distinct.

The insured’s letter will explain in

detail why the claim was denied

and information on how to appeal

a claim denial. The group’s letter

will be more generic in nature

regarding the claim being denied

(for privacy purposes).

What You Need to Know About Waiver of Premium:

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Long Term Disability Insurance Claim Guide

Founded in 1961, Madison National Life Insurance Company, Inc. is headquartered in Madison, the

rapidly growing capital city of Wisconsin. Madison National Life is licensed in 49 states and specializes

in group life, disability and specialty health insurance. The company is a wholly owned subsidiary of

Horace Mann Educators Corporation (NYSE:HMN), the largest nancial services company focused on

providing America’s educators and school employees with insurance and retirement solutions.

Underwritten By:

PO Box 5008, Madison, WI 53705

Marketed By:

Corporate Headquarters: 250 South Executive Drive, Suite 300, Brookeld, WI 53005-4273

Ofces Nationwide: 800.627.3660 www.NISBenets.com