Claims Standard Practices Administrative Guide and Frequently Asked Questions

Transcription

1 CREDIT DISABILITY INSURANCE CREDIT LIFE INSURANCE Claims Standard Practices Administrative Guide and Frequently Asked Questions Common Purpose. Uncommon Commitment. This informative document explains common claims practices and processes important to follow at your credit union. It also includes answers to frequently asked claims questions. If you have additional questions or need special assistance or instructions, you may call the Lending Claims Contact Center at Four-Step Claims Administration Process 1 Pre-Claim Gathering Information and Support Documentation You ll need member and loan information to submit a disability or life claim. Member Information Needed Member s name, address, date of birth, gender Date of loss/ type of loss Date the loan was insured Occupation (Credit Life claim only) Loan Information Needed Plan name (Single or Joint Disability Coverage) If Joint Disability Coverage, need Co-Borrower Name & Date of Birth Verify type of Credit Life coverage (Single or Joint) Account number/ loan number Payment amount and frequency (monthly, bi-weekly, etc.) and payment due date Is this a balloon loan? (Credit Disability only, if applicable) Date balloon loan payment is due (Credit Disability only, if applicable. Please refer to your certificate for details regarding balloon loans) Principal balance on the date of loss Loan Class Date of last payment prior to loss Annual interest rate Verify if the loan is open-end or closed-end Original date loan was granted Original loan amount Date loan was insured Was this loan previously insured by a different plan? If yes, provide original date the loan was insured Verify if there were advances prior to the date of loss Is Credit Disability premium included in the monthly payment? Is Credit Life premium included in the monthly payment? Last date premium was charged prior to loss Amount of Credit Disability and Credit Life premium charged prior

2 1 to the loss Was the loan refinanced within the past two years? If yes, provide the loan refinanced date (Continued) Pre-Claim Gathering Information and Support Documentation You ll need, or may need, certain documents to process a claim. Always Will Need Credit card accounts -- copies of account statements for six months prior to the date-of-loss through the present date Death certificate (Credit Life claim only) May Need You may be asked to provide the following: Copies of loan records (for example, the loan history statement from the data processing system; the loan application) Credit Insurance Application and Certificate Premium payment information Evidence of Insurability (if required at initial enrollment) 2 Claim Submission Immediately file a claim with CUNA Mutual Group. It should be no later than five business days from notification (Even if there is a waiting period, still file immediately). You can complete and submit a claim using two methods: electronic and paper. ONE: Electronic Claims Submission (preferred method) Submit via Claims Online * Go to Select My Services (upper left toolbar) Submit via Fax TWO: Paper Claims Submission Toll free fax number: To the attention of: Life and Disability Claims Dept. Log in with your User ID and Password Submit via Mail Go to the Claims tab and click on Lending CUNA Mutual Group Claims Credit Claims Online To the attention of: Life and Disability Claims Dept. P.O. Box 667 If supporting documents are required or requested, Waverly, IA submit via fax: Toll free fax number: To the attention of: Life and Disability Claims Dept. * For a Claims Online Tutorial, go to the Lending Resource Center. 2

3 (Continued) Claim Submission Discontinue charging Credit Life premiums after the date of death. If Credit Life premiums were charged to the borrower s loan after the date of death, the credit union should reimburse those charges for the borrower and request a refund from CUNA Mutual Group. To request a refund, please contact Payment Protection Services at Ext , option 1 or PaymentProtectionServices@cunamutual.com. Remember to update data processing codes appropriately once the claims decision is made: If Credit Life benefit was paid in full and there is no balance remaining on the impacted loan, the data processing codes should be adjusted accordingly: If the impacted loan has Single or Joint Credit Life, update the code on your data processing system to No Protection for Credit Life. If the impacted loan has Single or Joint Credit Disability, update the code on your data processing system to No Protection for Credit Disability. If Credit Life benefit was paid, but a balance remains on the impacted loan, the data processing codes should be adjusted accordingly: If the impacted loan has Single or Joint Credit Life, update the code on your data processing system to No Protection for Credit Life. If the impacted loan has Joint Credit Disability, update the code on your data processing system to Single Credit Disability. If the impacted loan has Single Credit Disability, determine which borrower has the Single Credit Disability coverage. o o If the remaining borrower is the insured member under the Single Credit Disability coverage, the code should remain Single Credit Disability. If the deceased borrower is the insured member under the Single Credit Disability coverage, update the code on your data processing system to No Protection for Credit Disability. If Credit Life benefits were denied on the impacted loan, the data processing coverage codes should be adjusted accordingly: If the impacted loan has Single Credit Life, update the code on your data processing system to No Protection for Credit Life. If the impacted loan has Joint Credit Life, update the code on your data processing system to Single Credit Life. 3

4 3 In-Progress Claim Activity Almost all of the communication from this point will happen between CUNA Mutual Group and the member and his/her doctor or health care provider. Claim Form Activity - Member Claim Form Activity CUNA Mutual Group Disability Complete member portion of form Give the form to the doctor/health care provider Doctor/health care provider completes medical portion Member or doctor sends completed form to CUNA Mutual Group Disability Send claim form to member Review completed form received from the member Make decision within seven business days Life Review claim Make a decision 4 Informing A decision is made and the claim is either approved or denied. Denied Member and credit union sent letter of explanation (Credit Disability) Credit union will receive letter explaining why (Credit Life) Credit union can provide copy of letter to next of kin or representative they are working with (Credit Life) Approved CUNA Mutual Group sends benefits reflecting period of disability verified by the doctor (Credit Disability) or lump sum (Credit Life), along with Explanation of Benefits Benefits must be posted within 5 business days Member and credit union receive documentation explaining details of the payment and any further action that may be required (Credit Disability) 4

5 Steps to Checking the Status of a Claim You and your members can check the status of a claim online..checking Status Credit Union Go to Click My Services (second tab on the toolbar). Log in using your User ID and Password. Checking Status Member Go to: This website will also be on their first Explanation of Benefit (EOB) letter. Go to Lending Claims/Premium Services section (may need to expand to see list of selections). Select Credit Claims Online. From Claims Online Home, determine the product (ex: credit life and credit disability) then Click Here. Once in Claims Online, click on the Search Claim in the left navigation. From Claim Search, click on the claim number to proceed to Benefit List. Click on Status tab (Claims Online tab toolbar) to indicate if the claim is registered, paid, denied, or payable. For additional questions on the status of a claim, please call the Lending Claims Contact Center at , Monday through Friday from 7 a.m. to 6 p.m. CST. 5

6 Identifying and Handling Member Inquiries and Complaints It s important to know the difference between a member inquiry and complaint. Understanding these differences help you know what action to take in order to best help members. You may always contact CUNA Mutual Group at if you need help determining the difference between an inquiry and a complaint. An inquiry is: Member Inquiry A request for general information about benefits. A question about the status of a claim. A statement of opinion without a request for further action. Member Complaint A customer complaint is: A written or verbal communication, which primarily expresses a grievance and where resolution is expected. Complaint examples: What is it? 1. The delays on my claim are frustrating. They keep saying they didn't receive the information that I know I sent, please get this resolved. 2. I was told my claim was going to be paid but now I'm told it won't be. I want something done to fix this. 3. My whole loan payment is not being covered by this insurance. They aren't treating me fairly and I want the difference paid immediately. What action should you take? Answer the question or provide the requested information. Request input from CUNA Mutual Group if necessary by calling the Lending Claims Contact Center at Immediately refer the complaint to CUNA Mutual Group. Use the following process: 1. Report the complaint contact our Lending Claims Contact Center at Provide the following information: Member name, address and phone number Claim number (if applicable) Date complaint was received Nature of complaint (copy of written complaint or notes on verbal complaint) Resolution the member expects 3. Member may contact CUNA Mutual Group directly* (if preferred) at *Be sure to contact CUNA Mutual Group and report the complaint even if the member wishes to contact us directly. 6

7 Claims Administration Frequently Asked Questions Q: What is the overall lifecycle of a disability claim? A: The claim process includes: 1. Your credit union member elects insurance coverage on a loan. An Insurance Certificate is issued. 2. A covered member event occurs, such as an accident or illness. 3. Your member contacts your credit union to file a claim. 4. Your credit union reviews the Credit Insurance Application to confirm that the member, with the claim, is insured with the credit disability coverage. 5. Your credit union files a claim. 6. CUNA Mutual Group sends an Initial Claim Report to the member for completion. 7. The member fills out the member portion of the Initial Claim Report and then sends the report to their doctor for completion of the medical information portion. 8. The doctor completes the Initial Claim Report and sends the form back to CUNA Mutual Group. 9. CUNA Mutual Group staff assigns the claim to a Senior Claim Professional. 10. A decision to pay, deny or request more information is made (usually within seven business days). If information is missing, the Senior Claim Professional will have to request the missing information to process the claim. NOTE: This may delay the processing of a claim. 11. Claim decision documentation is sent to your member and/or credit union. 12. Once a decision is made, the result will generate documentation. If the claim is denied, both the member and your credit union will receive letters explaining why. If the claim is paid, both parties will also receive documentation explaining the details of the payment and any further action that may be required. Q: What is the overall lifecycle of a life claim? A: The claim process includes: 1. Your credit union member elects insurance coverage on a loan and an Insurance Certificate is issued. 2. A covered member s death occurs. 3. Your member s executor contacts your credit union to file a claim. 4. Your credit union reviews the Credit Insurance Application to confirm that the member, with the claim, is insured with the credit life coverage. 5. Your credit union files a claim and submits the death certificate. 6. CUNA Mutual Group staff assigns the claim to a Claims Specialist. a. A decision to pay, deny or request more information is made usually within seven business days. b. If information is missing, the Claim Specialist will have to request the missing information to process the claim. NOTE: This may delay the processing of a claim. 7. Claim-decision documentation is sent to your credit union. The credit union is asked to communicate the decision to the individual handling the member s estate. Q: What contract number should be provided with notice of claim? A: Please provide the contract or branch number assigned to the location where the member elected and was issued the insurance coverage. If the coverage was provided over the telephone or on-line, please provide the home office credit union contract number. 7

8 Q: Should I file a claim even if I think it will be denied? A: Yes. You should file all claims immediately. It is a violation of insurance law to make a decision on whether a claim is payable unless you are licensed as an insurer or granted authority by an insurer. Therefore, all claim decisions must be made by CUNA Mutual Group. Q: Should I wait to file a claim until waiting periods are past? A: No. You should file all claims immediately, even if your contract includes a waiting period. Do not wait for waiting periods to end or until members bring you additional documentation. You should also never delay a credit disability claim for a future event (such as a planned surgery). File all claims immediately when the member notifies you. Q: How long does the claim process take? A: Over 85% of claims will be reviewed and decisions made to pay, deny or request additional information within seven business days of receipt of the claim. Prompt payment of claims is dependent on timely receipt of information from the member. Q: What are the deadlines for providing proof of Total Disability? A: Proof of Total Disability is required as soon as possible and no later than the period outlined in your policy/certificate. For example, 15 months from the date total disability begins. Q: When a member refinances (rewrites) a previously insured loan and elects Credit Disability Insurance on the refinanced portion of the loan. How do I determine the insurance effective date? How do I indicate the previously insured funds? A: The most recent loan date would be the insurance effective date. Indicate any money added to the previously existing loan balance as an advance and add a comment when filing a claim to indicate the previously insured loan effective date. Please include a description of the member s loan and insurance history in the comment. Faxing the loan and/or insurance documentation is recommended. Q: How are payments made? A: When a claim is paid, the payment is always sent directly to your credit union to satisfy the member s loan, never to the member. The payment may be sent by check or electronically. In both situations, an Explanation of Benefits letter (EOB) will accompany the payment. If the member remains disabled, additional updates will be requested during the life of the claim either through a verbal contact or a supplemental claim form. Q: What if the benefit payments for a Credit Life claim exceed the balance left on the loan? A: All excess Credit Life benefit payments must be paid to the named secondary beneficiary. If no secondary beneficiary is named, pay the member s estate, or apply benefits to another account held by the deceased member. Q: What should we do if the covered loan is paid off before benefits can be fully applied? A: Notify CUNA Mutual Group when a loan has been paid off so that we can determine whether benefits will continue. Continuation of benefits is determined based upon state law and terms of the group policy, and may also depend on the specific reasons the loan is paid off. Depending on these situations, benefits may or may not stop. 8

9 Q: Are there any loan amounts not included in benefits? A: Benefits may not cover some fees and charges such as late fees, unscheduled or additional finance charges or balloon payments. Please refer to your policy/certificate for specific details. Any Advances that are excluded from benefit payments under the terms of this insurance, or any money added to the principal balance of the loan after the date of the event, even if any of those amounts were incurred while a claim was being reviewed, are excluded and are solely the member's responsibility. Q: What online resources are available for my credit union? A: The Lending Resource Center contains several resources to help with claims including Claims Online Tutorials and guides: A step-by-step guide available to answer general questions pertaining to using Claims Online. The link to this guide is located on the same page used to access Claims Online in the Lending Resource Center. Q: What reports are available? A: Reports containing information regarding status of claims filed with CUNA Mutual Group within a specified date range can be obtained for your credit union. If your credit union needs a report, please contact our Customer Service Center toll-free at Q: Are there any self-service options for members? A: Members can view claim and payment status through or they can call our Customer Service Center at , Monday through Friday from 7 a.m. to 6 p.m. Q: Who can the member or I contact if we have questions about a claim? A: For additional information on the claim process or an individual claim, please contact our Lending Claims Contact Center toll-free at Q: Can I share information about a claim or status with the member s family? A: Claim information, including communication regarding the existence of a claim, is confidential and should never be disclosed to third parties, including family members, unless authorized by the member. Make sure your procedures include protection of confidential member information. Q: If a member prefers to have all correspondence sent via but we don't have their address, can we enter our credit union address in the member's field? A: No. If you do not have an address for the member, all correspondence will be sent by mail until we obtain a valid address for the member. Q: What are the different types of Loan Classes? A: Loan Classes are: Consumer, Credit Card, and Home Equity for all states except New York (NY). Loan Classes for New York (NY) ONLY are: New Auto, Used Auto, Credit Card, Home Equity, Secured Other, and Unsecured. 9

10 Q: What should I do regarding Credit Life premiums on the borrower s loan when I submit a death claim? A: Discontinue charging Credit Life premiums after the date of death. If Credit Life premiums were charged to the borrower s loan after the date of death, the credit union should reimburse those charges for the borrower and request a refund from CUNA Mutual Group. To request a refund, please contact Payment Protection Services at Ext , option 1 or PaymentProtectionServices@cunamutual.com. Remember to update data processing codes appropriately once the claims decision is made: If Credit Life benefit was paid in full and there is no balance remaining on the impacted loan, the data processing codes should be adjusted accordingly: If the impacted loan has Single or Joint Credit Life, update the code on your data processing system to No Protection for Credit Life. If the impacted loan has Single or Joint Credit Disability, update the code on your data processing system to No Protection for Credit Disability. If Credit Life benefit was paid, but a balance remains on the impacted loan, the data processing codes should be adjusted accordingly: If the impacted loan has Single or Joint Credit Life, update the code on your data processing system to No Protection for Credit Life. If the impacted loan has Joint Credit Disability, update the code on your data processing system to Single Credit Disability. If the impacted loan has Single Credit Disability, determine which borrower has the Single Credit Disability coverage. o If the remaining borrower is the insured member under the Single Credit Disability coverage, the code should remain Single Credit Disability. o If the deceased borrower is the insured member under the Single Credit Disability coverage, update the code on your data processing system to No Protection for Credit Disability. If Credit Life benefits were denied on the impacted loan, the data processing coverage codes should be adjusted accordingly: If the impacted loan has Single Credit Life, update the code on your data processing system to No Protection for Credit Life. If the impacted loan has Joint Credit Life, update the code on your data processing system to Single Credit Life. 10