Short-Term Disability Insurance Claim Review Checklist

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1. Download the Checklist as PDF for Free and share it with your team for completion.
2. Use the Checklist directly within the Mobile2b Platform to optimize your business processes.

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Below is a checklist that can be used when reviewing a short-term disability insurance claim:

1. Eligibility: Was the policyholder eligible to file a claim under their group or individual short-term disability (ST-D) insurance plan?

2. Effective Date: Is the date the policyholder became disabled on or after the first day of coverage for ST-D benefits, as specified in the policy?

3. Definition of Disability: Does the condition that prevents the policyholder from working meet the definition of disability outlined in the policy? This could include a list of specific illnesses or injuries.

4. Notice Period: Was proper notice given to the insurance company within any required timeframe after the policyholder became unable to work due to illness or injury?

5. Documentation: Are there adequate medical records and/or other supporting documentation (e.g., doctors' notes, test results) that confirm the policyholder’s inability to work due to their condition?

6. Disability Percentage: If applicable, does the policyholder meet the required percentage of disability as defined by the insurance policy? This might be based on lost wages or hours worked.

7. Earning Capacity: Has the policyholder's ability to engage in any occupation (despite not being able to do their own job) been considered?

8. Pre-existing Conditions: Is the disabling condition a pre-existing one that could have impacted eligibility for coverage before the policy was purchased or in-force?

9. Benefit Period: Does the length of time the policyholder has been disabled fall within the specified benefit period outlined in the insurance contract? This is usually a certain number of weeks, months, or years after the onset of disability.

10. Policy Exclusions and Limitations: Are there any specific exclusions or limitations mentioned in the policy that could affect the claim’s validity?

11. Waiting Periods: Has the required waiting period before benefits are paid been met? This is a period where no claims can be made until after a certain amount of time has passed from the start of the policy.

12. Review of Supporting Documents: Are all necessary documents, including but not limited to medical records, pay stubs, and any other requested information, available for review?

13. Compliance with Plan Rules: Are there clear violations or inconsistencies in how the claim was submitted versus what is stated within the policy details?

By using a STDI claim review checklist, your organization can:

Reduce administrative burdens and costs associated with reviewing claims Ensure consistency and fairness in claim decisions Identify and address potential issues before they become major problems Streamline the claim review process, reducing processing time and turnaround times Improve employee experience and satisfaction by providing clear and timely communication on claim status Enhance compliance with regulatory requirements and industry standards

1. Claimant's demographic information
2. Date and type of disability
3. Description of job duties and work requirements
4. Medical evidence supporting claim (doctor notes, test results)
5. Leave or time-off policies in effect at the time of injury/disability
6. Supporting documentation for any related claims (workers' comp, unemployment benefits)