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Employers

Employer Bulletin

All WRS Employers
Vol. 18, No. 4
February 16, 2001

Income Continuation Insurance and Long Term Disability Insurance Claim Process Changes Effective March 1, 2001

Effective March 1, 2001 the process for filing an Income Continuation Insurance (ICI) or Long Term Disability Insurance (LTDI) claim will no longer require a paper claim form from the employee. If your employee becomes ill or injured and is expected to meet the filing requirements (ICI elimination period, service requirements, etc.) for ICI or LTDI, instruct them to call CORE, INC. at 1-800-960-0052 to file a claim.

An employee who is applying for LTDI benefits should still contact Employee Trust Funds (ETF) toll free at 1-877-533-5020 for an LTDI estimate or claim form if the employee wishes to file a paper claim instead of an electronic one.

Here's how the claim process works:

  1. The employee contacts CORE, INC. at 1-800-960-0052.
  2. The CORE customer service representative will collect basic information including name, Social Security Number, date of birth, and current mailing address.
  3. CORE will ask questions that relate to the employee's absence, such as: the nature of the disability, last day worked, the name, address and telephone number of their attending and/or treating physician, and any additional work-related information.
  4. CORE mails the following to the employee: an introductory letter, a medical release form, and a letter to be given to the physician. It is important for CORE to have the employee's current mailing address in order to send correspondence relating to the employee's claim.
    • The employee introductory letter explains how the program works and what to expect while the claim is pending.
    • The employee must sign the medical release form and return it to CORE or the employee's attending and/or treating physician immediately. Note: The attending and/or treating physician, clinic or medical records departments will not release confidential medical information to CORE without the employee's consent. Until that release is given, the claim cannot be processed.

For ICI Claims:

  • A registered nurse, hired by CORE, will call the attending and/or treating physician to obtain clinical information concerning the employee's disability.
  • The nurse may call the physician to arrange a return to work plan for the employee. The plan may include modified hours or restricted duties. CORE will contact the employer to determine if job modifications can be made. The employee will receive written correspondence from CORE regarding any determinations made on the claim.
  • CORE contacts the physician for an ongoing review of the employee's disability claim to obtain updates on the diagnosis, symptoms, treatment and return to work plan.
  • Prior to the employee's return to work date, CORE may call to confirm the employee's return to work plans if, at the last medical update, the physician did not indicate the possibility of an extension of the individual's claim.

For LTDI Claims:

  • The physician is still required to complete the ETF medical report form (ET-5303 or ET-5338) as required by Wisconsin Administrative Code ETF 50.48 (2).

For Employers:

CORE will contact the employer for employee information using the e-mail address provided or via telephone call or letter sent via U.S. Postal Service. If you do not have an e-mail address, and you would like the information faxed, provide CORE with a fax number. E-mail address changes should be directed to the Employer Communication Center at (608) 264-7900. Please note the information needed from the employer has not changed -- only the manner in which the information is requested has changed. Responses to CORE's requests may be sent via e-mail (ICILTDI@COREINC.com) or faxed (1-310-348-7126).

ICI/LTDI Claim Approval or Denial Notice

CORE will notify the employer of the ICI or LTDI claim determination using the e-mail address provided or by letter sent via U.S. Postal Service if e-mail was not available. ICI approval and denial notices will also indicate whether the ICI premium will be waived or the individual will be required to pay the premium.

If you, as the employer, disagree with the LTDI determination, you will need to request a departmental review from ETF. This request must be in writing and received by the Department within 90 days of the date of CORE's determination. Employees have the same opportunity to request a departmental review if they disagree with CORE's determination. This departmental review must be completed prior to the employee's appeal to the Group Insurance Board.

For an ICI claim, the employee must go through a reconsideration process with CORE prior to submitting a written request for a departmental review.

Income Continuation Insurance Transaction Report (ET-5901)

CORE must be notified whenever an employee receiving ICI benefits has one of the following events occur:

  • The employee returns to full-time employment.
  • The employee returns to part-time employment.
  • The employee will not be returning to work.
  • The employee dies.
  • Local employers only - Any time vacation, sick leave, comp time, etc., are paid after the employee's selected elimination period.

The ICI Transaction Report (ET-5901) for employees who have returned to part-time employment must be faxed to CORE by 12:00 p.m., Central Standard Time, the Friday before the biweekly scheduled payday. Timely submission of earnings information is required in order for the claimant to receive their ICI benefit check on the scheduled payday. If the employee is on a monthly pay schedule, the ET-5901 should be sent to CORE as soon as possible after the close of the month. Fax the ICI Transaction Report (ET-5901) to CORE, INC. at 1-310-348-7126.

The ICI Transaction Report (ET-5901) can be found on the Internet at http://badger.state.wi.us/agencies/etf under Employers. For those who do not have access to the Internet, a supply of forms may be ordered from CORE through the use of the Income Continuation Insurance Forms/Booklets Order Form.

Income Continuation Insurance Application (ET-2307) and Evidence of Insurability (ET-2308)

You should continue to send the Income Continuation Insurance enrollment forms to ETF.

CORE is responsible for contacting you regarding any issues that may occur while processing the Income Continuation Insurance Application (ET-2307) form. CORE will send you a request for a correction or notify you if the application is denied. In addition, CORE will notify you of the Evidence of Insurability (ET-2308) approval or denial.

Contacting CORE

When contacting CORE by telephone, you will be given the following options:

  • If you know your party's extension, please press 1, the extension number and the # sign.
  • If you are calling to report a new claim, please press 2.
  • To check your enrollment application status, please press 3.
  • For payment inquiries, please press 4.
  • For all other inquiries, please press 5 or remain on the line for the next available representative.

CORE representatives are available from 7:45 a.m. to 4:30 p.m. CST, Monday through Friday, except State holidays. Callers can also leave voice-mail messages 24 hours per day, 7 days per week.

Please contact the Employer Communication Center at (608) 264-7900 with questions.

 

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