Waiver of Premium
Requirements Filing a Claim for Waiver of Premium
This provision should be used in lieu of the Filing a Claim provision in the Claim Provisions section of the certificate when filing a claim for Waiver of Premium. Provide notice of a claim for Waiver of Premium under this certificate as soon as possible. If there are any questions on how to file a claim, please contact us or your Employer. You must notify us immediately when you return to work in any capacity, regardless of whether you are working for your Employer. Step 1 - Starting a Claim Notice of a claim may be provided in Writing, online at: services.unum.com , or by contacting us directly at 1-800-635-5597. Notice and proof of a claim must be provided within 90 days after the end of the Elimination Period. If it is not reasonably possible to provide notice of claim within this time period, it will not affect your claim if you show that it was not reasonably possible to provide such notice and you provide such notice as soon as it is reasonably possible. Step 2 - Claim Forms Claim forms may also be available from your Employer or from us online at: services.unum.com. The form has instructions on how to complete and where to send the claim. We will send a claim form to you within 15 days from the date we receive your request for a claim form. If you do not receive a claim form from us within 15 days after we receive your request for a claim form, you should submit a Written statement as to the nature and extent of the disability. This will be considered Proof of Loss. Step 3 - Proof of Loss Proof of Loss, provided at your expense, must establish the nature and extent of the disability and include, but not be limited to the following: - the date you were first unable to work due to Injury or Sickness; - the existence and cause of your Injury or Sickness; - that your Injury or Sickness causes you to have Restrictions and Limitations limiting you from performing the Material and Substantial Duties of your Gainful Occupation; - proof that you are under the Regular and Appropriate Care and treatment by a Physician; - the name and address of any Hospital where treatment was received, including all attending Physicians; and - documentation of your financial records, upon request and where appropriate, including but not limited to, Earnings and income tax returns. If the Proof of Loss is not complete, we may require you to submit additional information. Upon consideration of the required proof, we will notify you in Writing as to whether we will waive the premium for your life insurance coverage. Any such waiver of premium will end in accordance with the End of Waiver of Premium provision. Step 4 - Continuing Proof of Loss At our request, you must provide continuing Proof of Loss for your continuing disability during the duration of your claim. We will request continuing Proof of Loss as often as it is reasonably necessary to do so, but not more frequently than once every six months. It must be sent to us within 45 days from the date of our request. After you or your authorized representative have satisfied the requirements of this provision, we will process and evaluate the information to determine if a claim is payable. We will notify you or your authorized representative of a claim decision and issue payment for a Payable Claim in accordance with the Payment of Benefits provision in the Claim
UA-GTLC21-1
Group Life and Accidental Death and Dismemberment Certificate
(1/1/2025) 23
Unum Life Insurance Company of America
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