Frequently Asked Questions (FAQs)
PW_A108084
What are the general items required when submitting a Life claim?
 | Group Policyholder's Statement |
| Beneficiary Claim Form |
| Enrollment Form and any beneficiary changes |
| CERTIFIED death certificate |
What additional information is required when submitting an Accidental Death and Dismemberment (AD&D) claim?
A police report should always be submitted with the initial claim. Upon review of this report, other possible items needed may include, toxicology report, autopsy report, Fire Marshall report, and medical records. Requirements depend on what type of accident it was.
What is the standard turn around time for processing a Life claim?
Five days.
What is the standard turn around time for processing an AD&D claim?
Five days from when we receive the additional items needed as stated above.
What determines whether or not interest will be paid with a Life claim?
It is based on the state laws. We look at the contract situs state, the state of the insured's residence and the state of the beneficiary. Whichever state is more favorable to the beneficiary, we use that state's laws to determine if interest is payable.
How is a Life claim paid when there is no beneficiary designation?
It will be paid according to the facility of payment provision in the contract.
How is a Life claim paid when there is a dispute on who the actual beneficiary(s) is?
If the dispute cannot be settled amongst the disputing parties, then the claim may have to be interpleaded. This means the claim is paid into the courts and it is up to the court to determine how the proceeds should be distributed.
How is a Life claim paid when the designated beneficiary has predeceased the insured?
If the primary beneficiary(s) have predeceased the insured, then it will be paid to the contingent beneficiary(s). If there is no contingent beneficiary(s), then it will be paid according to the facility of payment provision in the contract.
What steps are taken when we are unable to locate a beneficiary when processing a Life claim?
We have use of a database system from an outside vendor that we can access via our computers. We have been very successful in locating missing beneficiaries.
What are the general items required when submitting a Waiver of Premium (WOP) claim?
Generally, an Employer Statement, Employee Statement, Attending Physician Statement, Enrollment Card and Beneficiary Designation are required. Depending on the circumstances of the claim, additional information (i.e. payroll/salary verification, medical records, etc.) may be requested.
When should a WOP claim be filed?
The claim should be filed at the end of the qualifying period. Please refer to the contract to determine the specific qualifying period.
What is the standard turn around time for processing a WOP claim?
Once the complete claim is received, the claim is processed within 10 business days.
Once a WOP claim has been approved how often do we follow up to recertify the claim?
Generally, the updated medical information is requested and reviewed on an annual basis. However, certain individual circumstances of a claim can cause this review to be more or less frequent.
Do we continue to follow up on a regular basis as long as the insured remains covered under WOP?
In most cases, we do not request updated medical information once the insured attains age 65. We do still periodically contact the insured to verify their address and to confirm that they have not returned to work.
What steps are taken if we lose contact of an insured while under WOP?
We have use of a database system from an outside vendor that we can access via our computers. We have been very successful in locating missing beneficiaries.
Can WOP coverage be converted to an individual policy under certain circumstances?
Yes. Coverage can be converted at anytime the benefits are reduced or terminated. The insured will receive a conversion letter and form giving them the appropriate contact information if they desire to pursue converting the reduced/lost coverage.
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