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David Geffen School of Medicine at UCLA Graduate Medical Education
 
Claim Information

WHEN DO YOU OR YOUR AUTHORIZED REPRESENTATIVE NOTIFY UNUM OF A CLAIM?

We encourage you or your authorized representative to notify us as soon as possible, so that a claim decision can be made in a timely manner.

If a claim is based on your disability, written notice and proof of claim must be sent no later than 90 days after the end of the elimination period.

If a claim is based on death, written notice and proof of claim must be sent no later than 90 days after the date of death.

If it is not possible to give proof within these time limits, it must be given no later than 1 year after the proof is required as specified above. These time limits will not apply during any period you or your authorized representative lacks the legal capacity to give us proof of claim.

The claim form is available from your Employer, or you or your authorized representative can request a claim form from us. If you or your authorized representative does not receive the form from Unum within 15 days of the request, send Unum written proof of claim without waiting for the form.

If you have a disability, you must notify us immediately when you return to work in any capacity, regardless of whether you are working for your Employer.

HOW DO YOU FILE A CLAIM FOR A DISABILITY?

You or your authorized representative, and your Employer must fill out your own sections of the claim form and then give it to your attending physician. Your physician should fill out his or her section of the form and send it directly to Unum.

WHAT INFORMATION IS NEEDED AS PROOF OF YOUR CLAIM?

If your claim is based on your disability, your proof of claim, provided at your expense, must show:
  • that you are under the regular care of a physician;
  • the date your disability began;
  • the cause of your disability;
  • the extent of your disability, including restrictions and limitations preventing you from performing your regular occupation or any gainful occupation; and
  • the name and address of any hospital or institution where you received treatment, including all attending physicians. We may request that you send proof of continuing disability indicating that you are under the regular care of a physician. This proof, provided at your expense, must be received within 30 days of a request by us.

    If claim is based on death, proof of claim, provided at your or your authorized representative's expense, must show the cause of death. Also a certified copy of the death certificate must be given to us.

    In some cases, you will be required to give Unum authorization to obtain additional medical and non-medical information as part of your proof of claim or proof of continuing disability. Unum will deny your claim if the appropriate information is not submitted.

    WHEN CAN UNUM REQUEST AN AUTOPSY?

    In the case of death, Unum will have the right and opportunity to request an autopsy where not forbidden by law.

    HOW DO YOU DESIGNATE OR CHANGE A BENEFICIARY? (Beneficiary Designation)

    At the time you become insured, you should name a beneficiary on your enrollment form for your death benefits under your life insurance. You may change your beneficiary at any time by filing a form approved by Unum with your Employer. The new beneficiary designation will be effective as of the date you sign that form.

    However, if we have taken any action or made any payment before your Employer receives that form, that change will not go into effect.

    It is important that you name a beneficiary and keep your designation current. If more than one beneficiary is named and you do not designate their order or share of payments, the beneficiaries will share equally. The share of a beneficiary who dies before you, or the share of a beneficiary who is disqualified, will pass to any surviving beneficiaries in the order you designated.

    If you do not name a beneficiary, or if all named beneficiaries do not survive you, or if your named beneficiary is disqualified, your death benefit will be paid to your estate.

    Instead of making a death payment to your estate, Unum has the right to make payment to the first surviving family members of the family members in the order listed below:
  • spouse;
  • child or children;
  • mother or father; or
  • sisters or brothers. If we are to make payments to a beneficiary who lacks the legal capacity to give us a release, Unum may pay up to $2,000 to the person or institution that appears to have assumed the custody and main support of the beneficiary. This payment made in good faith satisfies Unum's legal duty to the extent of that payment and Unum will not have to make payment again.

    Also, at Unum's option, we may pay up to $1,000 to the person or persons who, in our opinion, have incurred expenses for your last sickness and death.

    HOW WILL UNUM MAKE PAYMENTS?

    If your life claim is at least $10,000, Unum will make available to the beneficiary a retained asset account (the Unum Security Account).

    Payment for the life claim may be accessed by writing a draft in a single sum or drafts in smaller sums. The funds for the draft or drafts are fully guaranteed by Unum.

    If the life claim is less than $10,000, Unum will pay it in one lump sum to your beneficiary.

    Also, your beneficiary may request the life claim to be paid according to one of Unum's other settlement options. This request must be in writing in order to be paid under Unum's other settlement options.

    WHAT HAPPENS IF UNUM OVERPAYS YOUR CLAIM?

    Unum has the right to recover any overpayments due to:
  • fraud; and
  • any error Unum makes in processing a claim. You must reimburse us in full. We will determine the method by which the repayment is to be made.

    Unum will not recover more money than the amount we paid you.

    WHAT ARE YOUR ASSIGNABILITY RIGHTS FOR THE DEATH BENEFITS UNDER YOUR LIFE INSURANCE? (Assignability Rights)

    The rights provided to you by the plan for life insurance are owned by you, unless:
  • you have previously assigned these rights to someone else (known as an "assignee"); or
  • you assign your rights under the plan(s) to an assignee. We will recognize an assignee as the owner of the rights assigned only if:
  • the assignment is in writing, signed by you, and acceptable to us in form; and
  • a signed or certified copy of the written assignment has been received and registered by us at our home office. We will not be responsible for the legal, tax or other effects of any assignment, or for any action taken under the plan(s') provisions before receiving and registering an assignment.

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