Employer Bulletin

All WRS Employers
Vol. 18, No. 14
August 24, 2001

Income Continuation Insurance (ICI) and Long Term Disability Insurance (LTDI) Claim Process Filing Instructions

The Department of Employee Trust Funds (ETF) has developed an instruction sheet for employers to distribute to employees considering filing a claim for Income Continuation Insurance (ICI) or Long-Term Disability Insurance (LTDI) benefits. The claim filing instruction sheet, Claim Filing Instructions for the Income Continuation Insurance (ICI) and Long-Term Disability Insurance (LTDI) Plans (ET-5106), can be found on the ETF Internet site at badger.state.wi.us/agencies/etf or it can be ordered through CORE, INC. via e-mail at ICILTDI@COREINC.com.

The instruction sheet provides the employee with the CORE, INC. toll free number and explains what will happen when a claim is filed over the telephone. If an employee plans to file a claim for ICI benefits, please give the employee the most recent version of the Income Continuation Insurance brochure (ET-2106) State or (ET-2129) Local (revised 2/21/2000), along with the instruction sheet. The brochures are available on the ETF Internet site or can be ordered through CORE, INC. via e-mail.

E-mail Inquiries to CORE, INC.

There are several ways in which employers and employees may contact CORE, Inc. These include submitting inquiries via e-mail to CORE, INC. operations at ICILTDI@COREINC.com. To expedite the e-mail request, please use the following subject lines:

ICI/LTDI – Customer Service Issue
ICI/LTDI – Payment Information
ICI/LTDI – Pending Claim
ICI/LTDI – Overpayment
ICI/LTDI – Rehabilitation
ICI/LTDI – Adverse Decisions
ICI/LTDI – Other
ICI/LTDI – Ombudsman Escalation

The correspondence unit at CORE forwards the e-mail internally and simultaneously sends an e-mail message back to the sender, confirming receipt. E-mails will be tracked for follow-up within 10 calendar days from receipt as outlined in the contract with CORE.

Escalating Issues and Communication with CORE, INC.

ETF and CORE, INC. have developed and implemented an escalated issue process (Ombudsman), for employers and employees to use for focused research and resolution on issues or communications that have not been satisfactorily addressed through the initial escalation processes.

Employers and employees are asked to first request a Customer Service Lead or Claims Supervisor to resolve the situation, prior to escalating the issue or complaint to the Ombudsman.

Referrals to the Ombudsman function may be made by telephone (800-960-0052, ext. 7149) or through the e-mail address with the subject header ICI/LTDI – Ombudsman Escalation. The Ombudsman function hours of operation are Monday through Friday, 10:00 a.m. to 3:00 p.m. Central Standard Time. The Ombudsman will call back within 48 business hours on all messages received.

ICI Transaction Report (ET-5901)

Employers use the ICI Transaction Report (ET-5901) to report part-time earnings and return to work date(s) for employees receiving ICI benefits. This form is now available on the Department's Internet site to download, complete, and send to CORE, INC. as an e-mail attachment. Adobe Acrobat software is required to download and use the form, which is in PDF format.

Please note that an ICI Transaction Report (ET-5901) received after the cutoff date for ICI pay-date cycles will be applied to the next ICI pay-date cycle. Previously, the Department had indicated that these reports needed to be at CORE no later than noon on the Friday before the next pay date. The Department now requires employers to have these reports to CORE by noon on the Wednesday before the next pay date in order for the information to be entered into the pay system. In the case of no further ICI benefits due, the employee will have an overpayment that will need to be refunded to ETF (not CORE). An employee receiving a check may question you about the overpayment, expecting instead, that the earnings would be offset.

ICI Return to Work Process

Clinical management team members of CORE, INC. will contact employers to discuss modified and restricted return to work duties for employees receiving ICI benefits. The following steps are being used for this process:

1. CORE will contact the employee's designated employer ICI contact person.

2. CORE will inform the employer ICI contact person of the restrictions under which the claimant's physician will release the employee to return to work, including duration.

3. The employer will take one of the following actions immediately:

   • Inform CORE, INC. whether or not the employer will accommodate the restrictions,

   • Inform CORE, INC. that the employer representative will get back to CORE within 24 business hours with an answer on accommodating the restrictions, OR

   • Inform CORE if the 24-hour turnaround time cannot be met and provide a reasonable expectation when CORE will receive an answer on accommodating the restrictions.

4. CORE will continue to pay benefits if the restrictions cannot be accommodated.

5. CORE will clarify all uncertainties with the claimant's physician(s) including duration, lifting restrictions, bending, frequency of breaks, etc.

It remains the responsibility of the employer to monitor for ADA compliance when discussing whether or not to accommodate the restrictions.

Long-Term Disability Insurance (LTDI) Employer Certification

Wisconsin Administrative Code §ETF 50.48 (3) requires that the employer complete certification based on the medically determinable impairment described on the claim. With the new telephonic claim process, a copy of the claim form is no longer sent to the employer.

As a result, ETF has revised the LTDI Employer Certification (ET-5315) to include the description of the disability as reported by the employee in question #8 on the ET-5315. This will serve as the notice of disability upon which the employer may make certification.

Questions about information indicated in question #8 and questions about other areas of this Bulletin should be directed to CORE, INC. Dial toll-free 1-800-960-0052.