STD Nh 4/6/15 - Week 2

What are three factors that may influence or prolong the duration of disability for a claimant with Major Depression?

Under policy # 215527, what are two exclusions?

You receive a disability claim for Jamie Barber and you approve benefits. After a few weeks of payment, Ms. Barber wants to change the amount of FIT & SIT that are being withheld from her check. What do you require to change the taxability on an SI claim?

In the CXC Premier Contract used for the Group Contract Training, what are 5 sources of income that are not deductible under the plan?

Covered under a CXC policy, Mark became disabled and unable to perform the material duties of his occupation as an engineer due to major depression. He received full benefits from Unum from 10/01/08 through 12/13/08. He returned to work as an engineer full-time on 12/14/08 with his original employer. On 12/30/08, he was admitted to the hospital due to a stroke and has been disabled ever since. Is his claim recurrent? Why or why not?

List three differences between Fully Insured (FI) claims and Self-Insured (SI) claims.

Please list the 4 service options offered to SI insured clients and provide a brief explanation of each.

The System Abbreviation for Earnings Definition is: SAL W/O DEF COMPThe employer provided the following information:Gross Bi-Weekly Earnings: $1,352.00W-2 Earnings: $58,263.00Bi-Weekly Pre-tax Contributions: $153.00What are the weekly earnings?

Using MDGuidelines, what is the diagnosis for ICD-9 code 431?

• A.

  High Blood Pressure

• B.

  Cerebral Hemmorhage

• C.

  Heart Attack

Is the coverage under policy #949060 contributory or non-contributory?

• A.

  Contributory

• B.

  Non-contributory

Under policy # 949060, what is the minimum hours requirement?

Answer the question below based on the following information."Weekly Earnings" means your gross weekly income from your Employer in effect just prior to your date of disability. It includes your total income before taxes and any deductions made for pre-tax contributions to a qualified deferred compensation plan, Section 125 plan, or flexible spending account. It includes income actually received from bonuses just prior to your date of disability but does not include commissions, renewal commissions overtime pay, any other extra compensation, or income received from sources other than your Employer. Bonuses will be averaged for the lesser of: a. the prior calendar years 52 week period of your employment with your Employer just prior to the date your disability begins; or b. the period of actual employment with your Employer.The employer provided the following information on the claim form: DOH07/01/99LDW02/12/09Semi-Monthly Earnings $1,200.00Prior Year Bonus$3200Semi-Monthly Pre-Tax Deductions$0.00What are the weekly earnings? 

Based on the following information, what is the claimant’s net weekly payment amount (before taxes) for the week of 03/26/14-04/01/14?Benefit Period: 03/26/14-04/01/14Gross disability payment: $950/weekState Disability (SD): $170/weekWorkers' Cpmpensation (WC): $160/weekMinimum Benefit $25Premiums: ER-paid (non-contrib)Assume the contract offsets for both SD and WC.

If Unum is named as the "Claims Fiduciary" for an SI plan, we assume all claim decision-making authority and discretionary authority with respect to: (please select all that apply)

• A.

  Eligibility for benefits

• B.

  Adverse claim decision

• C.

  Initial Claim approval

• D.

  All appeal decisions

• E.

  Any subsequent litigation (in most cases)

What is the default method in which we send carbon copy letters to the employer on Fully Insured policies? (unless otherwise specified by Special Handling)

• A.

  Mail

• B.

  Fax

• C.

  E-mail

Based on the following information, please answer the questions below."Weekly Earnings" means your gross weekly income from your Employer in effect just prior to your date of disability. It includes your total income before taxes and any deductions made for pre-tax contributions to a qualified deferred compensation plan, Section 125 plan, or flexible spending account. It includes income actually received from commissions but does not include renewal commissions, bonuses, overtime pay, any other extra compensation, or income received from sources other than your Employer. Commissions will be averaged for the lesser of: the 52 full calendar week period of your employment with your Employer just prior to the date your disability begins; or the period of actual employment with your Employer” The employer provided the following information:  Semi-monthly Earnings$1054.78Prior Year W-2 Earnings$43, 200.57Commissions$2000/yearYear to Date Bonus$5000.00What are the weekly earnings? 

You receive a disability claim for Jose Mendelson and you approve benefits. After a few weeks of payment, Mr. Mendelson calls to advise he made a mistake when he completed his claim form and wants to change the amount of FIT & SIT that are being withheld. Mr. Mendelson requests a refund of taxes on benefits already paid. Can we process his request?

• A.

  Yes

• B.

  No