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Disability and Life
Online Claims
Submission
User Manual for Employees
Life and Disability products underwritten by UniCare Life & Health Insurance Company. ® Registered mark of WellPoint, Inc.
7/13
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Table of Contents
Introduction ................................................................................................................................................... 3
Getting Started .............................................................................................................................................. 4
Submitting an Accidental Dismemberment claim ........................................................................................ 5
Submitting a Living Benefit claim .............................................................................................................. 12
Submitting a Life Waiver of Premium claim .............................................................................................. 19
Submitting a Short Term Disability claim .................................................................................................. 28
Submitting a Long Term Disability claim .................................................................................................. 37
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Introduction
Our online claim submission site provides a convenient way for you to submit disability claims (short term and long
term disability) and life waiver of premium, accidental dismemberment and Living Benefits claims. It saves you
time by not having to mail or fax your claim to us and can speed up the process because your claim gets sent directly
to our system.
This manual offers step-by-step instructions on how to submit your claims online. If you have questions, you can
call us at:
For life claims: 800-552-2137
For disability claims: 800-813-5682
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Getting Started
You’ll select the type of claim you want to submit on the Welcome screen. The options are:
Accidental Dismemberment
Living Benefit
Life Waiver of Premium
Short Term Disability
Long Term Disability
Fields marked with an asterisk* are required.
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Submitting an Accidental Dismemberment claim
To submit a claim for an accidental dismemberment, select “Accidental Dismemberment” in the Type of Claim
field. In the Type of User field, select “Employee.”
Enter the characters you see in the bottom box, then click “Next.”
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A pop up message will appear showing the additional forms you will need to complete your claim.
You can click on the links to download and print fillable PDF versions of the forms:
Employer’s Statement
Attending Physician Statement
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Please give us as much information as possible on the Employee/Employer Information screen.
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On the Accident Information screen, give us as much information as you can about the accident that
caused the loss.
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If you have completed at the time you enter the claim, you can scan them and upload them on this
screen. For example, if you have Employee’s Statement and/or Attending Physician Statement you
can scan and attach them here.
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Next you’ll get confirmation of the information you entered and you’ll give your certification to us
that we can begin processing the claim. You can also enter your email address and we’ll send you
confirmation of all the information you entered.
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Once the claim is complete, you’ll receive a confirmation summary showing all the information you
entered. If you entered your email on the prior screen you’ll also get a confirmation summary by
email.
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Submitting a Living Benefit claim
To submit a claim for a Living Benefit (Accelerated Death Benefit), select “Living Benefit” in the Type of
Claim field. In the Type of User field, select “Employee.”
Enter the characters you see in the bottom box, then click “Next.”
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You can print the forms we need to process the Living Benefit claim from this screen. Click on the
links to get fillable PDF files of the forms:
Employer’s Statement
Attending Physician Statement
Disclosure Statement
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On the Employee Information screen, you’ll give us the information we need to begin processing of
the Living Benefit claim. Be sure to give us as much information about the medical condition as you
can.
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You’ll enter your Employer’s contact information on the Employer Information screen.
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If you have forms completed at the time you enter the claim, you can scan them and upload them on
this screen. For example, if you have Employee’s Statement, Attending Physician Statement, and/or
Disclosure Statement you can scan and attach them here.
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Next you’ll get confirmation of the information you entered and you’ll give your certification to us
that we can begin processing the claim. You can also enter your email address and we’ll send you
confirmation of all the information you entered.
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Once the claim is complete, you’ll receive a confirmation summary showing all the information you
entered. If you entered your email on the prior screen you’ll also get a confirmation summary by
email.
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Submitting a Life Waiver of Premium claim
To submit a claim for a Waiver of Premium for life insurance, select “Life Waiver of Premium” in the Type of
Claim field. In the Type of User field, select “Employee.”
Enter the characters you see in the bottom box, then click “Next.”
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You can print the forms we need to process the Life Waiver of Premium claim from this screen. Click
on the links get fillable PDF files of the forms:
Life Waiver of Premium Employer’s Statement
Life Waiver of Premium Attending Physician Statement
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On the Employee/Employer Information screen, you’ll give us the information we need to begin
processing your Life Waiver of Premium claim. Be sure to give us as much information about the
medical condition as you can.
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Next, you’ll give us information about your disabling condition. Be sure to provide as much detailed
information as you can.
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Continued
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If you have forms completed at the time you enter the claim, you can scan them and upload them on this
screen. For example, if you have the Life Waiver of Premium Employer’s Statement or Life Waiver of
Premium Attending Physician Statement, you can scan and attach them here.
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Next you’ll get confirmation of the information you entered and you’ll give your certification to us
that we can begin processing the claim. You can also enter your email address and we’ll send you
confirmation of all the information you entered.
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Continued
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Once the claim is complete, you’ll receive a confirmation summary showing all the information you
entered. If you entered your email on the prior screen you’ll also get a confirmation summary by
email.
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Submitting a Short Term Disability claim
To submit a claim for Short Term Disability, select “Short Term Disability” in the Type of Claim field. In the
Type of User field, select “Employee.”
Enter the characters you see in the bottom box, then click “Next.”
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You can print the forms we need to process the Short Term Disability claim from this screen. Click
on the links get fillable PDF files of the forms:
Attending Physician Statement
Individual Authorization Form
Reimbursement Agreement
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Enter your contact information and all the information you have about your disabling condition. Be
sure to give us as much detail as you have, to help us process your claim.
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Next, enter your Employer’s contact information and information about your job.
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Next, you’ll give us information about your disabling condition. Be sure to provide as much detailed
information as you can.
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Be sure to provide as much detail as you can to help us in processing your claim.
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If you have forms completed at the time you enter the claim, you can scan them and upload them on this
screen. For example, if you have the Attending Physician Statement, Individual Authorization Form,
and/or Reimbursement Agreement you can scan and attach them here.
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Next you’ll get confirmation of the information you entered and you’ll give your certification to us
that we can begin processing the claim. You can also enter your email address and we’ll send you
confirmation of all the information you entered.
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Once the claim is complete, you’ll receive a confirmation summary showing all the information you
entered. If you entered your email on the prior screen you’ll also get a confirmation summary by
email.
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Submitting a Long Term Disability claim
To submit a claim for a Long Term Disability, select “Long Term Disability” in the Type of Claim field. In the
Type of User field, select “Employee.”
Enter the characters you see in the bottom box, then click “Next.”
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You can print the forms we need to process the Long Term Disability claim from this screen. Click on
the links get fillable PDF files of the forms:
Attending Physician Statement
Individual Authorization Form
Reimbursement Agreement
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You’ll enter your contact information and your Employer’s contact information on this screen.
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Be sure to give us as much information about your job as you can.
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Enter informaiton about the disabling condition on this screen. Be sure to provide as much detail as
you can to help us in processing your claim
The questions will change based on the Reason Stopped Work chosen:
Illness
Injury
Maternity
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No matter the Reason Stopped Work chosen, you will need to give as much informaiton about your
doctor and your other income as possible.
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Continued
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If you have forms completed at the time you enter the claim, you can scan them and upload them on this
screen. For example, if you have the Attending Physician Statement, Individual Authorization Form,
and/or Reimbursement Agreement you can scan and attach them here.
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Next you’ll get confirmation of the information you entered and you’ll give your certification to us
that we can begin processing the claim. You can also enter your email address and we’ll send you
confirmation of all the information you entered.
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Once the claim is complete, you’ll receive a confirmation summary showing all the information you
entered. If you entered your email on the prior screen you’ll also get a confirmation summary by
email.