ACMActive Claims Management. Used to refer to claims once liability has been accepted.
ADL’sActivities of Daily Living such as toileting, transferring, dressing, preparing meals, and ability to manage finances.
APSAttending Physician Statement.Primary Care Physician
BASBenefit Administration System—UNUM Provident’s payment computer payment system.
BMBBasic Monthly Benefit – BME x 60% or your contractual percentage. Gross Monthly Benefit
BMEBasic Monthly Earnings –Pre-disability salary or prior year W-2 earnings.
CCSCustomer Care Specialist
CMICurrent Monthly Income. Calculated generally by internal CPA’s as it relates to IDI claims.
COFCContinuity of Coverage provision in the policy.
CXCCurrent series of policies.Some are “Disability Solutions”, which means they contain additional specific provisions on which your claim may be denied.
CPIConsumer Price Index.Used to index your pre-disability earnings if you return to
partial work.
DBSDisability Benefit Specialist
DODDate of Disability
EDOCEffective Date of Coverage. The first date the claimant is eligible for benefits.
EMSIOut Sourced Agency who collectsmedical information.
ERDExpected Resolution Dates.
ERISAEmployment Retirement Income Security Act of 1974
FCEFunctional Capacities Evaluation. A medical form UNUM may provide to you to fill out.
GenesisOld Diary system on which the chronological record of your claim was kept.
GENEXGENEX Services, Inc. A wholly owned medical and vocational subsidiary of UNUMProvident.
HxHistory, referring most often to medical history.
IAIndependent Assessment—up to date term for IME
ILInitial Liability. Used to refer to a claim which is being reviewed. Payment decision is not yet made.
ImageAll paper is now scanned onto an electronic optical system called Image. This is where the administrative record is now kept. UNUM is moving toward a “paperless” claim environment.
IMEIndependent Medical Evaluation—old term, but used interchangeably with IA.
Lab OneThe new outsourced service used to obtain medical records.
LDWLast day worked.
LTDLong Term Disability
LWOPLife Waiver of Premium. The first date you are eligible for a waiver of your life insurance premiums.
MARBMidAtlantic Regional Benefits.Old UNUM Life Regional Office Chicago
M&NMental and Nervous provision of the policy limiting benefits to 12 or 24 months. Of interest is that the 24 months need not be consecutive. Twenty four months refers to a TOTAL of 24 months of paid benefits for the duration of the claim.
MCRMedical Claims Review.
MDRMulti Disciplinary Roundtables.
MDRMulti Disciplinary Roundtables.Attempts by management to identify potential claim denials by requiring the claims handlers to “present” claims to the business and risk management interests of the company.
MUUPMarked Up Unpaid Claim. This is an initial claim (IL) which has been input on “Agreement”, the data base system used to keep track of policies and policyholders. A marked up and unpaid claim is one which has been marked up on he BAS payment system, therefore, the insurance reserve has been realized. MUUP claims are assigned to a claims payer and are expected to be reviewed within 35 days which is a very unrealistic benchmark.
NAVILINKNew Diary System on which the chronology of your claim is kept. Much less documentation than Genesis.
NERBNortheast Regional Benefits No longer exists. Old UNUM Life Regional Office. Portland ME
NYRBNew York Regional Benefits.Tarrytown. No longer exists. Old UNUM Life Regional Office.
OOWOut of Work
OSPOffice Staff Physician. Old acronym for UNUM Physician. Now, Provident calls the in-house physicians, Physician Consultants.
PACEBenefit payment system used for IDI claims.
PC or TPCPhone communication with the claimant. TPC refers to the initial phone interview with the claimant at the start of the claim, while PC is used for any other phone conversation with the insured.
PMIPrior Monthly Income. Acronym used primarily with IDI claims and is calculated by an internal CPA.
PMSIOut sourced service retained by UNUM to obtain all of your medical records.
Pre-xPre-existing condition. Refers to policy provisions which relate to conditions of pre-existing conditions.
RIMARERisk Management Resources. The old UNUM Life training manual thought by many to be a claims
R&L’sRestrictions and Limitations. Medical information received from treating physicians should
list or describe restrictions and limitations which would
preclude work capacity. Restrictions are those activities
the claimant may never do while limitations are those
activities the claimant may do, but only as described by the
physician. i.e. No driving, no exposure to stressful
situations are examples of restrictions. No lifting > 10
lbs, no walking more than 10 minutes, alternate sitting and
standing are examples of limitations. The purpose of UNUM’s
medical review is generally to determine whether the R&L’s
provide o UNUM are reasonable and preclude work capacity for
the functional capacity given.
RTRRoundtables referring to either Team or MDR Roundtable presentations.
RTWReturn to Work.
SHUShoo! Special Handling Unit in Chattanooga. Extended Duration Unit in other UNUM locations.
SRBSouthern Regional Benefits Old UNUM Life Regional Office. Atlanta
SSSocial Security
SSDISocial Security Disability Income—a reduction from benefits
SSISocial Security SupplementalIncome—for lower income claimants
SSRSocial Security Retirement
STDShort Term Disability
SuppSupplemental Form. Medical form sent to the claimant for the physician to complete.
TDTotally Disabled. Used in the context of TD own occ or TD any occ. This means the claimant is totally disabled from performing the material and substantial duties of his/her own or any occupation.
TDOOTotally disabled from ownoccupation.
Team RTRTeam Roundtable. Another presentation to Consultants, Medical, Vocational personnel to attempt to identify “quick hits” claim denials.
TSATransferable Skills Analysis.2, 3, and 5 year partial or residual claims change from an own occupation definition to an any occupation definition after the mentioned time period. In order to prove the claimant is not TD any occupation, the claims handler will refer the claim to Vocational Specialists who in turn request GENEX to identify occupations the claimant could perform given their current R&L’s. Although the process appears rather elaborate on paper, the result is a best guess at what the claimant could do. Specific jobs are identified by the TSA. These occupations are then determined to be “gainful” or “not gainful” as identified by the provisions of the policy. A LMS may also be performed to further investigate whether the occupations identified by the TSA are available in the same geographical area as the claimant. The TSA and LMS process is totally “out of contract” and is defined by UNUM as the process used to investigate any occupation.
WCWorker’s Compensation—a reduction from benefits
XL or XLLUNUM Life Insurance Series Policies (Old)