"Total disability" means the employee's complete inability to perform the material duties of his or her regular job.
Regular job is the job performed on the day before total disability began.
After 12 months of disability, "total disability" means the employee's complete inability to perform the material duties
of any gainful job for which he/she is reasonably fit by training, education or experience.
To be considered totally disabled, the employee must also be under the regular care of a physician, and must not be
performing the duties of any gainful job.
How Do I Get Started
In order to process a claim on your behalf please mail us the following:
Before faxing any of the forms, call each office for a contact name
Mail or Fax the form directly to your contact person
Instruct your contact person to complete all the information required, including titles, signatures and dates
Instruct your contact person to FAX the forms to our office at (213) 620-0598
Do You Have Your Forms Yet?
Pre-existing Condition Limitation Clause
Pre-existing conditions mean an injury or illness, for which the member incurred charges, received medical treatment,
consulted a physician, or took prescribed drugs, within 6 months before he/she became insured by this plan.
If total disability is due to a pre-existing condition and it begins after 24 months after the member becomes
insured by this plan, such member is eligible for benefits. If the insured does not require any form of treatment or medication for the pre-existing condition, coverage begins after 12 months.
About your Deductions and Premium Collection
Paid Leave of Absence: If you are on a paid leave of absence for a disability, we will continue to
receive a payroll deduction for your Association insurance premium(s) until you either exhaust your
sick time or switch to an unpaid leave of absence. At that point, we will not be able to take a payroll
deduction for your insurance coverage. Then, our Accounting representatives, Leigh Thompson, or Trinh Pham
will bill you directly.
Waiver of Premium: When you are eligible to receive benefits, your disability premiums are waived.
Reinstatement: When you return to work, please make sure your Disability coverage is re-instated.
Provide all Pertinent Information: Inform our office of any changes in your income and your return to work.
The United States Life Insurance Company usually makes a decision in four to five weeks, after receiving the completed
claim forms. This is the case for the 90% of the claims.
If your disability claim is approved, The United States Life Insurance Company will pay your benefits.
Delays Can Happen:
Incomplete Forms
Delay in Providing Information: Every claim is unique. When the case is more complicated, the insurance company requests
additional information from the doctor, or from Worker's Compensation office and those providers delay their response.
Pre-Existing Conditions is one of the complications. If the employee has been insured for less than 2 years, the Insurance
Company will investigate if the disability is a pre-existing condition. This procedure will take one or 2 months, depending
in how diligently your Doctor provides the Medical Records to the Insurance Company
