Help with Disability Insurance Claims
Handle claims smoothly and ease the return to work.
Get answers to your questions about how we manage and verify disability claims, how to file a disability claim and what services we offer to help you and your employee with the return to work.
Disability case management. We review each case early in the employee’s disability to identify options and assist in developing return-to-work programs. We use a variety of resources to promote high-quality, cost-effective results.
Skills assessment. Our vocational consultants evaluate the activities employees are able to proficiently perform to help them determine transferability to another job or occupation.
Job analysis and modification. We obtain a clear understanding of the job and evaluate possible modifications to facilitate a return to work.
Job placement/outplacement services. After reaching medical stability, if the claimant isn't able to return to work at his/her employer in the same capacity, we offer other services to assist the claimant in returning to work.
Counseling. We help individuals determine a career path and steps necessary to achieve their career goals through a variety of tools.
Onsite visits. During on-site visits, the rehabilitation consultant, nurse, claim analyst or a vendor gathers information about the claimant.
When you hear "accommodations" you may think of permanent job changes. This is not necessarily the case. An accommodation can mean several things and is not always permanent. Accommodations can include:
- Reduced work schedule allows employees to return to work part time, gradually increasing their hours to full time over a specific time period.
- Flexible work schedule allows someone to come in later, earlier or to take longer mid-day breaks than the typical 8:00 a.m. to 5:00 p.m. schedule. This can allow an employee time for medical appointments, therapy appointments or simply a resting period.
- Equipment/worksite accommodations can include desks, chairs, keyboards, foot stools and adaptive computer software.
- Remote work site may be an option if an employee's job be performed from home or an office that is closer to home if a lengthy commute is problematic. Although transportation to and from work does not qualify for disability benefits, a shorter commute can help reduce or eliminate stress from an employee's recovery.
- Job duty accommodations may be an option if another employee can handle job duties that would allow the employee to stay at work or return from disability earlier. Or, heavier items might be separated into smaller, more manageable weights may make the job duty more manageable.
When a disability happens, you as the employer should:
- Provide the employee (or family member) the claim form or your telephonic claim submission number.
- Complete the first page of a paper claim form which includes pertinent employer information needed for the claim.
- Help your employee understand the importance of providing the claim form to his/her physician as soon as possible as medical information is needed for the evaluation.
- Keep communication lines open with employees while they are out. This helps them feel that they will be welcomed back once they recover.
- Be open to temporary or flexible work arrangements while employees are recovering. A gradual (or part-time) return to work allows employees the ability to return to their job more quickly while easing back into their normal duties. Our Work Incentive benefit is an excellent vehicle to help this work for everyone.
- Show concern and compassion while respecting the employee’s privacy. Keep the lines of communication open and avoid asking about specific private health matters. Feel free to talk about when they are coming back to work and if there are any schedule accommodations or special equipment needed for their return.
- Discuss appropriate actions with Principal Life’s claim examiner.
- Online claim submission
- Fax: 800-255-6609
- Mail: Principal Life Insurance Company
Attn: Group Life & Disability Claims Department
Des Moines, IA 50392-0002
- Telephonic claim submission available upon employer request.
For STD, you should encourage the employee to file the claim as soon as you are aware that the employee will be off work beyond the elimination period. For LTD, we typically advise that the claim is filed no later than halfway through the LTD elimination period.
There are many advantages to filing a claim early. Early notification helps us be proactive in obtaining additional information that may be needed to make the initial claim decision. It also assists us in making timely decisions. Once the claim is filed, a claim manager is assigned to the claim. The claim manager will be your point of contact for any claim questions that may arise.
There are four sections to the claim form: the HIPAA Authorization, the Employer Section, the Employee section and the Physician section. All four sections must be completed. Note: If you have both STD and LTD coverages with Principal Life, and you have already filed an STD claim for your employee, you do not need to file a separate claim form for the LTD coverage.
Having the claim form completed in its entirety will assist us in our claim evaluation, as well as reduce our need to contact you for additional information. If the insured completes the online claim form or the telephonic claim form is completed by the employee, we will contact the employer to obtain additional information. The employer information must be provided by someone other than the claimant.
If your benefits are based on W-2 earnings and an employee has been employed for more than one calendar year, we ask that the employer provide a copy of the prior year’s W-2. For those employed less than one calendar year, we will need earnings for all completed months. If the claim is filed for an owner, please make sure to specify this on the form and we will contact you regarding what is needed for this situation.
For customers who have contributory coverage and are self-accounting groups, we request a copy of their enrollment form. This form assists us in verifying that an employee enrolled for coverage on a timely basis. It also shows us what coverage the insured elected.
Our goal for adjudicating STD claims is ten business days from the receipt of the claim. In circumstances where additional information is needed to make a decision, we will pend the claim until we receive the additional information.
We issue STD benefits on a weekly basis in arrears. For routine maternities and some routine surgeries, we offer a lump sum payout for the approved duration period. Claims will have a payment day equal to the accrual day. For example if the Elimination Period is satisfied on a Wednesday then the payment is issued Wednesday of the next week.
For insured business we do not automatically withhold state or federal taxes. These can be withheld at the claimant’s request. FICA tax is withheld for 6 months from the date last worked. For ASO business applicable state, federal and FICA tax are automatically withheld.
To be eligible for benefits, a person must meet the definition of disability according to the insurance policy. Objective documentation such as physician’s office notes, treatment records, hospital records or a physician statement may be required. If we are waiting for information from an outside source, the decision time will depend on when the information is received.
No. The employee must meet the definition of disability as defined by the policy. Medical information submitted must support the definition of disability and cannot be based simply on a physician’s opinion. Each claim is reviewed to determine if it meets the contractual requirements for benefit payment.
The claimant will be contacted with an acknowledgement letter within five business days of receipt of the LTD claim. A follow-up phone call will be made to conduct a phone interview to gather additional information. Our goal is to make the LTD decision by the later of 45 days from the receipt of the claim or by the completion of the elimination period.
A new claim form is not required when moving from STD to LTD when you have an integrated disability program. Our goal is to provide integrated claim processing to streamline claim administration. Some of the features of our integrated process include: single notification of claim, one claim form, smooth and timely transition from STD to LTD whenever possible, early intervention and case management.
If the group has life coverage with us, we will also automatically review for waiver of life insurance premium benefit.
Principal Life offers two monthly LTD payments options:
- Regular check - We will mail a check to the employee’s address on the benefit due date. LTD payments are made on the 10th of the month in arrears.
- Electronic Funds Transfer (EFT) - Employees can elect EFT, which allows us to transfer the employee’s LTD benefit to a bank account designated by the employee. We will transfer funds allowing sufficient time to reach the employee’s account by the benefit due date.
If there is a salary continuance offset in the other income source section of the policy then any salary continuance paid is directly reduced from the disability benefit. This doesn’t allow the employer to supplement income with salary continuance. If salary continuance is not included in the other income source definition then an employer can supplement the claimant’s income; however the weekly payment limit will limit the individual from receiving more than 100% of their Predisability Earnings.