| ACM |
Active Claims Management. Used
to refer to claims once liability has been accepted. |
| ADL’s |
Activities of Daily Living such
as toileting, transferring, dressing, preparing meals, and
ability to manage finances. |
| APS |
Attending Physician Statement.
Primary Care Physician |
| BAS |
Benefit Administration
System—UNUM Provident’s payment computer payment system. |
| BMB |
Basic Monthly Benefit - BME x
60% or your contractual percentage. Gross Monthly Benefit |
| BME |
Basic Monthly Earnings
–Pre-disability salary or prior year W-2 earnings. |
| CCS |
Customer Care Specialist |
| Clmt |
Claimant |
| CMI |
Current Monthly Income.
Calculated generally by internal CPA’s as it relates to IDI
claims. |
| COFC |
Continuity of Coverage
provision in the policy. |
| CXC |
Current series of policies.
Some are “Disability Solutions”, which means they contain
additional specific provisions on which your claim may be
denied. |
| CPI |
Consumer Price Index.
Used to index your pre-disability earnings if you return to
partial work. |
| DBS |
Disability Benefit Specialist
|
| DOD |
Date of Disability |
| Dx |
Diagnosis |
| EDOC |
Effective Date of Coverage. The
first date the claimant is eligible for benefits. |
| EE |
Employee |
| EMSI |
Out Sourced Agency who collects
medical information. |
| ER |
Employer |
| ERD |
Expected Resolution Dates. |
| ERISA |
Employment Retirement Income
Security Act of 1974 |
| FCE |
Functional Capacities
Evaluation. A medical form UNUM may provide to you to
fill out. |
| Genesis |
Old Diary system on which the
chronological record of your claim was kept. |
| GENEX |
GENEX Services, Inc. A wholly
owned medical and vocational subsidiary of UNUMProvident.. |
| Hx |
History, referring most often
to medical history. |
| IA |
Independent Assessment—up to
date term for IME |
| IL |
Initial Liability. Used to
refer to a claim which is being reviewed. Payment decision
is not yet made. |
| Image |
All 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. |
| IME |
Independent Medical
Evaluation—old term, but used interchangeably with IA |
| Lab One |
The new outsourced service used
to obtain medical records. |
| LDW |
Last day worked. |
| LTD |
Long Term Disability |
| LWOP |
Life Waiver of Premium. The
first date you are eligible for a waiver of your life
insurance premiums. |
| MARB |
MidAtlantic Regional Benefits.
Old UNUM Life Regional Office Chicago |
| M&N |
Mental 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. |
| MCR |
Medical Claims Review |
| MDR |
Multi 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. |
| MUUP |
Marked 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. |
| NAVILINK |
New Diary System on which the
chronology of your claim is kept. Much less documentation
than Genesis. |
| NERB |
Northeast Regional
Benefits No longer exists. Old UNUM Life Regional
Office. Portland ME |
| NYRB |
New York Regional Benefits.
Tarrytown. No longer exists. Old UNUM Life Regional Office. |
| OOW |
Out of Work |
| OSP |
Office Staff Physician. Old
acronym for UNUM Physician. Now, Provident calls the
in-house physicians, Physician Consultants. |
| PACE |
Benefit payment system used for
IDI claims. |
| PC or TPC |
Phone 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. |
| PMI |
Prior Monthly Income.
Acronym used primarily with IDI claims and is calculated by
an internal CPA |
| PMSI |
Out sourced service retained by
UNUM to obtain all of your medical records. |
| Pre-x |
Pre-existing condition. Refers
to policy provisions which relate to conditions of
pre-existing conditions. |
| RIMARE |
Risk Management Resources. The
old UNUM Life training manual thought by many to be a claims
manual. |
| R&L’s |
Restrictions 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. |
| RTR |
Roundtables referring to either
Team or MDR Roundtable presentations. |
| RTW |
Return to Work. |
| SHU |
Shoo! Special Handling
Unit in Chattanooga. Extended Duration Unit in
other UNUM locations. |
| SRB |
Southern Regional Benefits Old
UNUM Life Regional Office. Atlanta |
| SS |
Social Security |
| SSDI |
Social Security Disability
Income—a reduction from benefits |
| SSI |
Social Security Supplemental
Income—for lower income claimants |
| SSR |
Social Security Retirement |
| STD |
Short Term Disability |
| Supp |
Supplemental Form. Medical form
sent to the claimant for the physician to complete. |
| Sx |
Symptom |
| TD |
Totally 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. |
| TDOO |
Totally disabled from own
occupation. |
| Team RTR |
Team Roundtable. Another
presentation to Consultants, Medical, Vocational personnel
to attempt to identify “quick hits” claim denials. |
| TSA |
Transferable 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. |
| Tx |
Treatment |
| WC |
Worker’s Compensation—a
reduction from benefits |
| XL or XLL |
UNUM Life Insurance Series
Policies (Old) |
