Here’s everything you need to know about how to submit an accidental death and dismemberment claim and what will happen after you submit it.
- Inform the plan sponsor of the death or loss.
- Find the forms you need to apply for accident benefits.
When should you submit an accidental death & dismemberment claim by?
Accidental and death and dismemberment claims should be submitted as soon as possible. Dismemberment claims must be provided within 15 months from the date of loss.
What happens after you submit a claim?
We’ll collect information about the coverage from your plan sponsor. If there’s any outstanding information required to assess the claim, we’ll let you know either through written communication or phone call. Once all information is received, we will review the claim details along with the group accidental death and dismemberment plan’s contractual provisions.
How long does it take to process/review a claim?
We aim to make a decision 7 calendar days from the date we receive all necessary information.
Please note: This timeline is intended for standard plans only. Actual timelines might vary based on plan design and claim complexity. Missing information or incomplete applications for benefits may impact processing timelines. We may need to extend the timeline if additional review is needed.
How do I know if my claim has been approved?
We’ll provide you with written confirmation of the claim decision (including benefit details).
How can I appeal a claim decision?
If benefits are denied, you’ll receive a detailed letter with an explanation for the decision. The letter will also include:
- Details on how to appeal the decision
- What information should be included in your appeal
- Where to send the appeal
The appeal process is deemed final once the second appeal decision is made.
Any further concerns may be escalated through our customer complaint process.