A

Approved
A status of "Approved" indicates that the claimant is currently receiving benefits under the terms of the Group Policy.


B

Benefits From Other Sources
Benefits from Other Sources (also called "Benefit Offsets," "Offsets" or "Other Income Benefits") are payments or income from other sources such as Social Security, Workers' Compensation, State disability, your employer's sick-leave plan or other programs, that may be available to you while disability benefits are payable. Under the provisions of the Group Policy, the insurer is permitted to subtract from your disability benefits any amounts you have or are eligible to receive from these or other sources. For more information, check with your employer or see your Employee Benefits booklet.


Benefits Suspended
A status of "Benefits Suspended" indicates that a claimant who was previously eligible to receive benefits, will no longer be receiving benefit payments. For more information about claims with a status of "Benefits Suspended," call our Customer Service Center at 1-800-247-6875.


C

Closed
A status of "Closed" usually indicates that a previously approved claim has been closed because of one or more reasons, which may include:

• All benefits for which the claimant was eligible have been paid
• The claimant is no longer disabled (i.e., claimant returned to work)
• The claimant is no longer eligible for benefits (i.e., claimant reached maximum age)
• The claimant is receiving other benefits that exceed the amount of the disability payment

For more information about claims with a status of "Closed," please see your Employee Benefits booklet or call our Customer Service Center at 1-800-247-6875.


D
Denied
A status of "Denied" indicates that a claim has been denied because of one or more reasons, which may include:

• The claimant is not eligible for benefits according to the provisions in the Group Policy
• The claimant is not disabled according to the provisions in the Group Policy

For more information about claims with a status of "Denied," please see your Employee Benefits booklet or call our Customer Service Center at 1-800-247-6875.


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I

Ineligible for Coverage
Ineligible for Coverage is one of several reasons for a claim's status to be marked "Denied." A claimant may be ineligible for coverage for different reasons including:

• The claimant was not covered by the Group Policy at the onset of the disability.

For more information about claims with a status of "Denied - Ineligible for Coverage," please see your Employee Benefits booklet or call our Customer Service Center at 1-800-247-6875.


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M

Maximum Age of Eligibility
Maximum Age of Eligibility is one of several reasons for a claim's status to be marked "Closed." A claimant who has gone beyond the maximum age of eligibility will no longer receive disability benefits. For more information , please see your Employee Benefits booklet or call our Customer Service Center at 1-800-247-6875.



N

No Benefits Payable
A status of "No Benefits Payable" indicates one of several things including, but not limited to:

• The claimant is eligible to receive benefits from other sources that exceed the amount of the benefits payable under the Group Policy
• The claim has gone beyond the maximum eligibility period

For more information about claims with a status of "No Benefits Payable," please call our Customer Service Center at 1-800-247-6875.


Not Disabled
Not Disabled is one of several reasons for a claim's status to be marked "Denied." There are different reasons why a claimant may be considered Not Disabled according to the provisions of the Group Policy. For more information about claims with a status of "Not Disabled," see your Employee Benefits booklet or call our Customer Service Center at 1-800-247-6875.


Not Medically Substantiated
Not Medically Substantiated is one of several reasons for a claim's status to be marked "Denied." For a claim for disability benefits to be approved under your employer's Group Policy, a claimant must submit proof of disability attested to by a qualified physician. If a claimant fails to provide proof of disability, the claim will be denied. For more information about claims with a status of "Denied - Not Medically Substantiated," see your Employee Benefits booklet or call our Customer Service Center at 1-800-247-6875.


O

Own Occupation
Own Occupation (or "Own Occ") is one way to define total disability. The term generally refers to the usual and customary duties of employment, business, trade, profession or vocation that you performed immediately prior to the onset of a disability. The definition of Own Occupation varies by Group Policy and by employer. For your Group Policy's definition of Own Occupation, and more information about how Own Occupation is used to determine eligibility for benefits, check with your employer or see your Employee Benefits booklet.


P
Pending Approval
A status of "Pending Approval" usually means that your claim has recently been entered into our system and we have not yet made a decision on it. A claim may be given Pending status while we wait for additional claim documentation from you, your employer or your physician. For more information, please call our Customer Service Center at 1-800-247-6875.


Pre-existing condition
Pre-existing Condition is one of several reasons for a claim's status to be marked "Denied." Your employer's Group Policy contains a complete description of "Pre-Existing Conditions" and how they affect claim processing. For more information, see your Employee Benefits booklet or call our Customer Service Center at 1-800-247-6875.


Q


R

Rehabilitation - Return to Work
Rehabilitation Return to Work indicates that the claimant has returned to work, or soon will be returning to work, for his/her employer and that the employer has made an arrangement or accommodation to aid the employee's return to work.


Return to Work
Return to Work is one of several reasons for a claim's status to be marked as "Closed." Other disability benefits may be applicable if the claimant does not return to work in a full time capacity. Your employer's Group Policy contains information about eligibility under this provision. For more information, check with your employer or see your Employee Benefits booklet.


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W

Work-related
Generally, group disability insurance policies exclude disabilities resulting from occupational illnesses and on-the-job injuries. Your employer's policy may contain an exclusion that provides that: "No benefit will be payable for any Total Disability that is due to:

• Injury or Sickness for which the Employee is entitled to benefit under any Workers' Compensation, Occupational Disease or similar law
• Injury or Sickness sustained while doing any act or thing pertaining to any occupation or employment for wage or profit"

Therefore, any disability due to a work-related injury or illness would be excluded and would not be covered under your employer's Group Policy. For more information, check with your employer, or see your Employee Benefits booklet.


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