Suspended or Waiting Claim Status

Who can you advise if the claim is awaiting information from the ER?

• ER

• EE

• BOTH

Suspended and Waiting statuses are not used interchangeably

• true

• false

Tags

CCSS.RI.11-12.8

CCSS.RI.8.7

CCSS.RI.9-10.7

CCSS.RL.11-12.8

CCSS.RL.9-10.7

What methods are used to notify employees about their claim status updates?

• text message

• IVR updates (if applicable)

• by phone

• in writing.

If the letter hasn't been generated, what information is generally required?

• Office notes

• Paystubs

• Medications

• Test results and physical therapy results

What is the first step to take when a claim requires special handling for LTD?

• Request additional documents from the claimant

• Notify the employer on the status of the claim

• Process the claim with no special instructions.

• Follow special handling for LTD or SHU LTD claim when it applies.

What should you advise the caller if a claim was previously approved then is moved to waiting status?

• Previous approval date.

• Contact their HR department.

• you should refer the caller to the Case Specialist

What steps should you take if the claim status is Suspended/Waiting because information was not received?

• • Check Scheduled Tasks/Claim History and CM Needs for indication of information needed to process the claim.

  
  

• • Obtain required information.

  
  

• • Determine if/which letter has been sent.

  
  

• Refer caller to CS.

Separate review timeframe for medical does not apply on initial claim decisions.

• True

• False