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Disability Benefits Claims Procedures
(test)Please follow these important instructions when submitting a Short-term and/or Supplemental Disability claim to Liberty Mutual. These procedures have been documented to provide those involved a clear outline of what transpires throughout the claim process.
Note for UCSF Medical Center employees: Please call 415/353-4545 for Medical Center Human Resources/Benefits claims procedures.
- Employee calls the UCSF HR/Benefits Office and provides the following information: name, address, department, social security number, date of disability, if disability is due to pregnancy, UC hire date, medical plan enrollment, disability plan enrollment: Short-term Disability plan? Supplemental Disability Plan?
- Benefits Office issues appropriate claim packet to employee. This claim packet includes:
- Liberty Mutual Disability Claim Form/with return envelope
- Attending Physician’s Statement,
- Disability Benefits Factsheet,
- Short-term/Supplemental Disability Summary Plan Description,
- Partial Disability Factsheet (Stay-at-Work/Return-to-Work),
- Enrollment, Change, Cancellation form (UPAY 850), for return from leave,
- Enrollment, Change, Cancellation form (UPAY 850), to add newborn (if applicable)
- State of California Disability Insurance (SDI) Claim Form (if employed at UC less than 18 months),
- Pregnancy And Newborn Child Factsheet (if appropriate),
- Kaiser Authorization/Disclosure form (if applicable),
- Employee Support Services brochure,
- Reimbursement Agreement form,
- Family Medical Leave Benefits Checklist (if applicable),
- DepCare/HCRA Enrollment, Change & Cancellation Form (UPAY 919) (if applicable),
- Health Care Reimbursement Account (HCRA) Summary Plan Description (if applicable).
- Benefits Office e-mails the UCSF Payroll Office (Insurance Section) notifying them that a claim form has been issued.
- Employee completes Disability Claim form. Doctor completes Attending Physician Statement. Both are sent directly to Liberty Mutual. The same procedure applies to the SDI claim form (if appropriate) which is sent directly to SDI.
- Employee contacts department/supervisor regarding disability leave, pay status, Family Medical Leave Act benefits, etc. (NOTE: 30 calendar days of sick leave (if available) must be exhausted according to the terms of the Liberty Mutual Contract. Use of additional sick leave, vacation leave or compensatory time is optional, not required.) Employee requests Leave-Of-Absence.
- Department places employee on Leave-Of-Absence* (via appropriate OLPPS Entry/Update procedures). (NOTE: LOA begins on the later of the following dates: The calendar day following the last day on pay status, OR, the date of disability.
- The Payroll Office compiles data pertaining to UC Statement for Liberty Mutual.
- Certifies enrollment, eligibility, and salary data on UC statement.
- Sends UC statement to employee’s department to verify payroll status (e.g., last day worked, date sick leave exhausted, last day on payroll status, etc.).
- Certifies enrollment, eligibility, and salary data on UC statement.
- Department provides information pertaining to UC statement (per instructions) and returns it to the Payroll Office.
- The Payroll Office electronically transmits all UC statement information to Liberty Mutual.
- The Payroll Office sends instructions to employee regarding actions employee must take in order to continue insurance during, and upon return from, an approved Leave-Of-Absence**.
- Liberty Mutual is generally able to process claims within 5 to 10 working days upon receipt of both employee/physician statements and UC statement.
- NOTE: If/when an employee has been on leave-of-absence for six months, the home department may request that a Return-to-Work Review be conducted by Employee/Labor Relations and Disability Management Services.
Resources and Contacts:
- UCSF Payroll Office/Insurance Section: 415/476-8428
- UCSF HR/Benefits: 415/476-1400
- Liberty Mutual: 800/838-4461
- State of California Employment Development Department (SDI)
San Francisco Office: 415/749-7400
Oakland Office: 510/577-2300
*It is important that all Leaves-Of-Absence Without Pay (LWOP) be documented and processed in order to provide for:
- System-generated notices regarding Basic (UC-Paid) Life Insurance conversion. Coverage ends following 4 calendar months while on approved LWOP. NOTE: Beginning with the end of coverage, there is a thirty-day window (only) to elect conversion. Contact UCSF HR/Benefits.
- Necessary documentation for purposes of establishing UCRP service credit (if desired) for the period on LWOP. NOTE: Beginning with the return from LWOP and employee may elect to buyback their UCRP service credit. Contact UCSF HR/Benefits for more details.
**Employees returning to pay status from a LWOP of more than one calendar month must reinstate all insurance. Enrollment forms must be received by the UCSF Payroll Office (Box 0812) or UCSF HR/Benefits Office (Box 0918) before the end of the last working day within a 31-day period upon return to pay status. Please be sure to notate: "Return from LOA [date]" on the Enrollment, Change, Cancellation form (UPAY 850) .