May I fax my new claim / updated paperwork?
Yes, our fax number is 518-640-8105
Did
you receive my claim paperwork?
We will notify you within 72 hours via phone of the
receipt of your new claim paperwork. At that
time, we will renew the claim process and advise you
of any missing information. We will also confirm
this call with a letter.
What is a Waiting
Period? A Waiting Period is a
period of time during which you are to work due to a
Covered Disability and during which you will not
receive benefits. For example, if you had a 7
day waiting period and went out on Covered Disability
on July 1st, the first day you would be paid benefits
is July 8th.
When will my
check be mailed? A number of factors impact
when a claim check will be mailed. Claims are
approved, declined or additional information is
requested within 15 business days of its receipt.
This will be discussed with you, when we call to
review your claim. The date the check will be
mailed depends on when all information is received.
Claim checks are usually mailed within 2 weeks of our
receipt of all information necessary to approve a
claim.
Do I have to pay premiums while I am out on claim?
Yes, you should continue to pay your premiums as they
come due. Upon approval of your claim, all
premiums due after 6 consecutive months will be waived
fax as long as you are eligible to receive benefits
for that disability.
Can I
pay my premiums over the phone?
We will bill you directly for premiums due once
payroll deductions stop. These premiums need to
be paid by check or money order. We do not have
the capability to take payments over the phone.
Why didn't I get a full month of benefits?
Benefits are paid on the information provided by your
doctor and employer. We will normally pay a
30-day benefit, unless there is information to
indicate you will be able to return to work sooner.
What is
a Pre-existing Condition? A
pre-existing condition is a condition for which
medical advice was given or treatment was recommended
or received from a doctor in the six (6) months prior
to the effective date of your initial insurance, or
subsequent increase in coverage.
Disabilities due to a pre-existing condition are not
covered. However, once you are insured under the
Policy for 12 consecutive months, (12 consecutive
months from the date of you coverage increase)
disabilities occurring after that due date to a
pre-existing condition are covered as any other
condition.
What other information is necessary to process my
claim?
-
If you were in a car accident or
were hurt on the job, we will need a copy of the
accident report from the police or a copy of your
employer's accident report.
-
If you were treated in an Urgent
Care or Emergency Room, we will need a copy of the
paperwork, indicating the date of treatment.
-
If you have been hospitalized, a
document showing the dates of hospitalization should
also be included.
-
A copy of your job description is
also helpful.
We need you to complete all
dates on the claim form and sign and date all forms.
This will expedite the processing of you claim!
If you have any questions, please do not hesitate to
contact: Charley Swartz
CSEA Sales Representative
phone: (585) 410-5443
fax: (866) 866-9076
email:
charles.swartz@pearlcarroll.com |
