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Once You’ve Applied: What Happens Next
IF YOU’VE APPLIED FOR BASIC OR VOLUNTARY
DISABILITY:
• Within a few days of receiving your claim, a case manager
from the insurance carrier will call you to guide you through
the process.
• To determine your eligibility, the carrier will review the
medical facts of your case in light of your job and occupation.
• Once the carrier has all the necessary information, it will
notify you in writing (within a few days) of whether your claim
has been approved or denied.
• Once your claim is approved, the carrier will mail checks to
your home every two weeks.
• If your claim is denied, the letter notifying you of the denial
will include information about your right to appeal.
CLAIM DENIALS
In the event that your claim is denied, either in full or in part, the
insurance carrier will notify you in writing within 90 days after the
later of your date of disability or the date your claim form was led.*
The carrier’s notice of denial shall include:
• The specic reason or reasons for denial with reference to
those policy provisions on which the denial is based;
• A description of any additional material or information
necessary to complete the claim and an explanation of why
that material or information is necessary; and
• The steps to be taken if you or your beneciary wish to have
the decision reviewed.
HOW TO APPEAL
You, the claimant, or your authorized representative, may appeal
a denied claim within 60 days after you receive the carrier’s
notice of denial. You have the right to:
• Submit a request for review, in writing, to the carrier;
• Review pertinent documents; and
• Submit issues and comments in writing to the carrier.
The carrier will make a full and fair review of the claim and may
require additional documents as it deems necessary or desir-
able in making such a review. A nal decision on the review shall
be made not later than 60 days following receipt of the written
request for review. If special circumstances require an extension
of time for processing, you will be notied of the reasons for the
extension, and a decision shall be made not later than 120 days
following receipt of the request for review. The nal decision on
review shall be furnished in writing and shall include the reasons
for the decision with reference, again, to those policy provisions
upon which the nal decision is based.
IF YOU’VE APPLIED FOR UCRP DISABILITY:
• Once the UC Retirement Administration Service Center
receives your application, you’ll be notied when specic
documentation is needed or if you need to take other actions.
You can reach out with questions by UCRAYS secure message,
or by contacting the UC Retirement Administration Service
Center at 800-888-8267. (Your information will be held in
condence and will be released or exchanged with others only
with your written consent.)
• If the medical evidence you submit is inconclusive, you may
need to have an independent medical examination.
• In most cases, UC partners with Lincoln Financial who will
conduct the medical evaluation and make a recommendation
of approval or denial. You will receive a packet of information
from Lincoln Financial shortly after the UC Retirement
Administration Service Center receives your application. UC
will make the nal determination of eligibility.
• UC may need to review your potential qualications for
other types of work. If so, you may be asked to meet with a
vocational rehabilitation professional to help you explore the
options available to you and/or regain the skills you need to
return to work.
• UC will review your case once it has the information it needs
from you, your medical providers and others. You’ll receive a
written notice of the decision.
• If your application is approved, you’ll receive a letter specifying
your UCRP disability date, the amount of your monthly
benet, the terms and conditions of the approval, your health
insurance coverage (if applicable) and when you can expect to
receive your rst payment.
• If you have been paying both employee and employer portions
of your medical, dental, legal and/or vision plan premiums,
you should contact UCPath to request reimbursement of any
premium costs that may be owed you.
• The rst payment you’ll receive will include benets
retroactive to your UCRP disability date (note that if you’re
receiving Voluntary Disability Income, you may owe some or
all of this amount to the disability insurance carrier). After
that, your benets will be paid at the rst of each month. For
example, your benet payment for May would be payable the
rst of June.
• If your application is denied, you’ll receive an explanation for
the denial in writing. If you don’t agree with the decision, you
have the right to appeal.
• Your request for an appeal must be submitted in writing within
60 days from the date you receive the denial notice and include
documentation to support your claim. Send the request to the
Disability Unit, UC Retirement Administration Service Center,
P.O. Box 24570, Oakland, CA 94623-1570.
Once You’ve Applied:
What Happens Next
* In the unlikely event that the carrier does not respond to your claim within the
time limits set forth above, you should automatically assume that your claim has
been denied and you should begin the appeal process at that time. However,
failure to do so will not waive your right to appeal.