(Certified Disability Nurse Case Managers assisting with troubleshooting your disability claim)
(For contents of Disability Guide see below)
Table of Contents
Overview/Introduction...........................................i-viii Why we felt that there was the need for this basic information, information specific to employees, employers and providers.
Before You File Your Disability Claim...................1-7 (for Private Disability Insurance versus your State Disability Claim) Points to consider prior to deciding to file your disability claim.
Completing Your Disability Claim Form..............8-13 The information required for a timely claim evaluation.
Your Diagnosis:......................................................14-22 The listed national codes for categories of medical conditions and an explanation of the difference between medical diagnosis, medical condition and function.
Your Occupation....................................................23-25 Categories of job descriptions and job classifications, information regarding how your job is evaluated with the medical information/functional status/limitations and restrictions provided for review.
What your Provider needs to know.....................26-31 Information that the provider needs to know to help insure a timely claim determination/evaluation.
Ongoing Disability Claims....................................... 32-33 What will be required for ongoing claims, what
additional information may be required, what are the expectations for longer duration claims?
Pregnancy claims...................................................34-38 Issues specific to pregnancy claims
Return to Work......................................................39-44 Issues regarding the return to work process, returning to your job.
What to do when your claim is denied.................45-48 Examples of why some claims are denied, discussion of information that is usually missing in denied claims and how you appeal your claim.
Health Insurance Portability and ........................49-53 Accountability Act (HIPAA)
What is HIPAA and how does it effect you and your claim process?
Your Rights under the Employee Retirement.........54-55 Income Security Act of 1974 (ERISA)
An explanation of what ERISA is and what it means to you the employee.
Social Security Disability Integration, Your.............56-57
State Disability and how it affects you
Basic information about Social Security Disability and how it differs from your private disability insurance.
State Disability for Residents of................................58
New York, New Jersey, Rhode Island, California, Hawaii, and Puerto Rico
A brief overview of what the employee should expect if they live in one of these states in regard to their benefits/income.
Family Medical Leave Act.........................59-66
An explanation of the Family Medical Leave Act and how it applies to your disability claim.
Checklist for Provider............................................... 67
Checklist for Employee............................................. 68
Checklist for Employer...............................................69
We defined the terms that are used in the insurance industry with regard to insurance policies and insurance issues and defined terms specific to our use of them in the following:
Is your condition also a Workers Compensation Case/Claim?.................110-112
