Long-term disability claim FAQs

Frequently asked questions

Contact DiMartino Associates at (206) 623-2430 for more information on your benefit waiting period. If you are not sure how long you will be absent or whether you should file a claim or not, we suggest that you file your claim. This offers you some peace of mind and allows The Standard to begin its review and issue a timely payment if appropriate.

 

Long Term Disability Claims

How do I file a claim?

To file a paper claim, contact DiMartino Associates at (206) 623-2430.

A typical application for disability benefits contains the following documents:
• Employee’s Statement
• Employer’s Statement
• Attending Physician’s Statement (APS)
• Authorization to Obtain and Release Information

When I report my claim, what information will I need to provide?

You will be asked to provide the following information – in addition to other questions about your absence:
• Policyholder: Washington State Council of Fire Fighters
• Group ID: 10141971
• Name and Social Security number
• Last day you were at work
• Nature of claim/medical information
• Physician’s contact information (name, address, phone and fax number)

Where do I send the completed forms?

Completed forms may be mailed to:
Standard Insurance Company
P.O. Box 2800
Portland, OR 97208

Or if you prefer, fax the completed forms to (800) 378-6053

What can I expect after I submit the completed forms?

Once The Standard receives the required paperwork, which includes the Employee’s Statement, Employer’s Statement, Attending Physician’s Statement and Authorization to Obtain and Release Information, your benefits analyst will contact you to discuss any additional information that may be necessary to complete the processing of your claim and to answer any of your questions.

If my claim for benefits is approved, how long will it take to receive my first check?

After the Benefit Waiting Period as outlined in your group policy is served, LTD benefit payments are paid in arrears on a monthly basis based on the date of disability and are mailed directly to your residence. LTD benefit payments that are payable for retroactive claims will be paid immediately following claim approval.

Who should I call with questions about my claim?

If you have already filed a claim, please call The Standard’s Disability Benefits toll-free number, (800) 368-1135. If you are looking for general information, please contact the Washington State Council of Fire Fighters.

Who is responsible for notifying my employer of my absence?

It is your responsibility to follow your employer’s absence reporting procedures by notifying your manager or supervisor of your absence

Basic Accident Insurance

Employee Basic AD&D Benefit

$15,000; paid to your beneficiary if you die as a result of an accident; partial benefit paid for certain dismemberments. See Schedule of Coverage.

Schedule of Coverage

(Refer to Policy Booklet for full Schedule of Coverage)

Loss of one hand or one foot

50% of Principal Amount

Loss of sight in one eye, speech or hearing in both ears

50% of Principal Amount

Two or more of the above losses

100% of Principal Amount

Thumb & index finger on same hand

25% of Principal Amount

Quadriplegia

100% of Principal Amount

Paraplegia

50% of Principal Amount

Hemiplegia

50% of Principal Amount

Benefit Reduction Schedule

Amount your benefit reduces to if you are still working: 50% at age 70, 40% at age 75 and 20% at age 80+

Child Care Benefit

The total child care expense incurred by your spouse within 36 months after the date of your death for all children under age 13, but not to exceed $5,000 per year or the cumulative total of $10,000 or 25% of the AD&D benefit, whichever is less

Public Transportation Benefit

The lesser of (1) $200,000 or (2) 100% of the AD&D benefit otherwise payable for the loss of your life

Occupational Assault Benefit

The lesser of (1) $25,000 or (2) 50% of the AD&D benefit otherwise payable for the loss of your life.

Line of Duty Benefit

Additional 100% of Principal Amount payable upon receipt of due proof that covered person, while serving in the Line of Duty, suffers a covered loss that results directly and independently of all other causes from a covered accident

Seat Belt Benefit

The lesser of (1) $10,000 or (2) the amount of AD&D benefit otherwise payable for the loss of your life

Higher Education Benefit

The tuition expenses for training incurred by your spouse within 36 months after the date of your death, exclusive of room and board, but not to exceed $5,000 per year, or the cumulative total of $10,000 or 25% of the AD&D benefit, whichever is less

Long-Term Disability Insurance

Benefit Waiting Period

90 days-Number of calendar days you must be disabled before a benefit is payable

Maximum Benefit Duration

To age 62

Monthly Benefit

60% of Covered Earnings; maximum $5,000/month

Minimum Benefit

$100/month

Definition of Disability

24 month Own Occupation; followed by Any Occupation for the remainder of the benefit period.

Own Occupation Period: For the first 24 months of your long term disability, you are disabled if you are unable to perform the material duties of your “own” occupation.

Any Occupation Period: After 24 months, you are disabled if you are unable to perform the material duties of “any” occupation which you are reasonably suited for, based on education or experience, and at which you can be expected to earn at least 60% of what you were making prior to becoming disabled.

Deductible income

Your benefit will be reduced by certain other income you are eligible to receive from other sources: Work Earnings, Sick Leave, LEOFF/PERS Retirement Benefits, Worker’s Compensation, Other Group Disability Benefits and Washington State PFML benefits. See Policy Certificate for full list of Deductible Income sources

LEOFF Integration

For the first 12 months that you are receiving your LEOFF or PERS retirement benefit, you may keep up to 100% of pre-disability earnings between the two. After 12 months, your LTD benefit is reduced by the amount you receive in LEOFF or PERS benefits, dollar for dollar.

Pre-Existing Condition Limitation

3 month look back / 3 month symptom free / 12 months insured

Mental Illness/ Substance Abuse Limitation

24 months per incident benefit for disabilities arising from a mental illness or from substance abuse.

Subjective Condition Limitation

24 months per incident for disabilities arising from a musculoskeletal issue or other subjective condition. See Policy Certificate for more information.

Taxation of Benefit

If monthly LTD premiums are paid with post-tax dollars, the LTD benefit will be tax-free to the member. If premiums are paid pre-tax, the benefit will be taxable.

This benefit summary is only a summary of the benefits and not intended to replace the specifics of the Plan Contract. If there is a discrepancy , the Plan Contract will supersede this summary.