Claim Provisions
Filing a Claim
Provide notice of a claim for benefits under this certificate as soon as possible. If there are any questions on how to file a claim, please contact us or 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 of a claim should be provided within 30 days from the date of the death or Covered Loss. If notice of a claim is not provided within this time period, it will not affect a Payable Claim as long as notice is provided as soon as reasonably possible. If the death or Covered Loss occurs before receiving notification of our decision on any Coverage Amounts subject to Evidence of Insurability Requirements, the coverage amount applicable to the claim will be the coverage previously approved and on file with us and your Employer. Step 2 - Claim Forms After receiving notice of a claim, we will send a claim form to you or your authorized representative within 15 days from the date we receive the notice of a claim. Claim forms may also be available from your Employer or from us online at: services.unum.com . When you or your authorized representative receive the claim form, you or your authorized representative and your Employer must fill out your own section of the claim form and provide the Insured's Physician with the applicable section of the claim form. The Insured's Physician should complete their section of the form and send it directly to us. If you or your authorized representative do not receive a claim form from us within 15 days after we receive notice of a claim, a Written statement from you or your authorized representative establishing the nature and extent of the Covered Loss or the death will be deemed Proof of Loss, if sent to us within the time limit stated in the Proof of Loss section below. Completed claim forms may be submitted online or sent to us by mail, or fax: Mailing Address: The Benefits Center P.O. Box 100158 Columbia, South Carolina 29202-3158 Fax: (800) 447-2498 Step 3 - Proof of Loss Proof of Loss must be sent to us no later than 90 days after the date of death or Covered Loss. If it is not reasonably possible to provide Proof of Loss within this time period, it will not affect a Payable Claim if it is provided within one year, unless the Insured lacks the legal capacity to do so. In no event can Proof of Loss be submitted after the expiration of the time limit for commencing Legal Action as stated in this certificate, even if the failure to provide Proof of Loss is due to a lack of legal capacity or if state law provides an exception to the one year time period. Proof of Loss, provided at your or your authorized representative's expense, must include, but not be limited to the following: - a certified copy of the death certificate or other lawful evidence providing equivalent information; - the date of Covered Loss; - the cause of death or Covered Loss; - 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,
UA-GTLC21-1
Group Life and Accidental Death and Dismemberment Certificate
(1/1/2025) 31
Unum Life Insurance Company of America
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