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Claiming Benefits
This section explains when and how to file claims for disability benefits. For more information on your rights with respect to claims, please see the " Plan Administration" section of this Guide.
How to File Claims
The claims process differs based on the type of illness or injury that causes you to have an approved disability as follows:
Non-Occupational Illnesses or Injuries
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It is your responsibility to provide your manager with as much advance notification as possible if you believe that you will be absent due to an illness or injury that will continue for eight or more consecutive calendar days.
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Advance notification will enable your manager to make the necessary arrangements to cover your work during your absence and to report your request for disability leave to the accessHR Contact Center via the Leaves Processing web site between the first and eighth consecutive calendar day of your absence. Timely reporting of your disability leave ensures a timely determination of the disability pay benefits for which you may be eligible.
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Upon learning of your disability leave from your manager, the accessHR Contact Center will send you a leave of absence packet that includes disability claims forms and the instructions for filing your disability claims to determine if you are eligible for disability pay benefits.
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You and your health care provider will be required to provide complete medical information to support your request for disability leave by sending the completed claims forms to the appropriate claims evaluator. Please Note: Any disability pay benefits for which you may be eligible will be suspended if you fail to provide the necessary medical information within the time frame required (i.e., within 15 calendar days). If you do not submit the required medical information and/or your claim is not approved within the subsequent time frame communicated to you, your claim will be denied and your employment may be terminated.
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The medical information requested of you must be supplied at your expense and in a timely manner for your request for disability leave to be evaluated — both initially and on an ongoing basis. You also will be required to provide signed authorization for JPMorgan Chase's appropriate claims evaluator to obtain and release all reasonably necessary information that supports your disability pay benefits claim.
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You should only provide your medical certification to the medical professionals who are responsible for reviewing your medical certification — it should not be provided to your manager, Human Resources Business Partner, or any other JPMorgan Chase employee.
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JPMorgan Chase reserves the right to require you to be examined by a licensed physician chosen by the firm, at the firm's expense, as often as reasonably necessary while your claim continues. Failure to comply with this examination may result in the denial, suspension, or termination of any disability pay benefits provided under this policy.
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If your approved disability leave could potentially continue beyond 25 weeks, your claim is automatically referred to the JPMorgan Chase Long-Term Disability Plan — as long as you elected coverage under that plan before becoming disabled. If your disability leave is not approved and you choose to apply for long-term disability benefits, please contact The Hartford directly.
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If you do not receive a letter, disability forms, or a phone call from the claims evaluator within 15 days of the first day of your absence, please call the accessHR Contact Center or your claims evaluator.
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The policy's claims evaluators will work with JPMorgan Chase and your licensed physician to determine when you may return to work.
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Your claim will either be approved or denied within 45 days of its submission to the applicable claims evaluator, unless you are notified in writing that special circumstances require a delay in the decision. If your claim is denied, you will be notified in writing and provided with instructions on how to appeal this decision.
Occupational Illnesses or Injuries
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If you believe that your illness or injury was sustained in the course of and arose out of work, you must immediately inform your manager — whether or not your illness or injury causes you to be absent — so that your manager can open a claim for any work-related illnesses or injuries directly to the JPMorgan Chase workers' compensation evaluator.
The JPMorgan Chase Workers' Compensation Program is insured and administered by Liberty Mutual, unless otherwise indicated below:
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Workforce Safety and Insurance — State Insurance Fund Program
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Please Note: To determine whether the BWC or Cambridge is your workers' compensation administrator, please refer to the "Information" section of the JPMorgan Chase Corporate Insurance Services web site at Company Home > Lines of Business > Corporate Groups > Global Finance > Global Finance Home > Select LOBS & Regions > Corporate Insurance Services.
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Department of Labor and Industries — State Insurance Fund Program
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BrickStreet Mutual Insurance Company
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Division of Workers' Compensation — State Insurance Fund Program
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Your manager should open a workers' compensation claim by contacting the applicable workers' compensation evaluator immediately to report:
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Your occupational illness or injury; and
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Any amount of lost time from work, if you are disabled by your occupational illness or injury.
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If you are absent on an intermittent basis, you should notify the applicable workers' compensation evaluator.
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If your illness or injury causes you to be absent from work for eight or more consecutive calendar days, your manager must report a workers' compensation leave of absence through the Leaves Processing web site.
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Upon learning of your disability leave from your manager, the accessHR Contact Center will send you a leave of absence packet that includes disability claims forms and the instructions for filing your disability claims to determine if you are eligible for disability pay benefits.
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You must provide medical documentation of your claim for disability to the applicable workers' compensation evaluator.
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The applicable workers' compensation evaluator will make a determination of your eligibility for benefits based on your disability.
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If your approved disability leave could potentially continue beyond 25 weeks, you will receive the claims forms necessary to apply for benefits under the JPMorgan Chase Long-Term Disability Plan, as long as you elected coverage under that plan before becoming disabled. If your disability leave is not approved and you choose to apply for long-term disability benefits, please contact The Hartford directly.
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To qualify for workers' compensation benefits, you must meet the state-mandated requirements of the workers' compensation law for the state in which you work. In addition, you must notify in a timely manner and file your claim, present medical evidence, and submit to independent medical exams when required by the applicable workers' compensation evaluator or the appropriate state Workers' Compensation Board or Industrial Commission.
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Once a claim is filed and approved, you should inform the applicable workers' compensation evaluator of any absences that are related to your claim.
Please Note: While you are receiving workers' compensation benefits, you may not receive state disability benefits because those benefits apply only to non-occupational disabilities. You will not receive more than 100% of your benefits pay between workers' compensation disability benefits and any disability pay benefits provided by JPMorgan Chase that you may be eligible to receive. Failure to reimburse JPMorgan Chase for any benefits you receive in excess of 100% of your benefits pay may result in corrective action, including termination of employment.
Appealing Claims
JPMorgan Chase is not involved in deciding appeals for any disability leave and/or disability pay benefits claim denied by The Hartford. All fiduciary responsibility and decisions regarding a claim for a denied benefit for employees who work in New Jersey and New York rest solely with The Hartford, and any appeals must be made in accordance with The Hartford's requirements. An appeals committee within JPMorgan Chase is responsible for deciding appeals for any disability leave and/or disability pay benefits claim denied by Disability Management Services (DMS) for employees working in all other states.
The process for filing an appeal varies based on the type of illness or injury that caused your disability and the state in which you work, as follows:
Non-Occupational Illnesses and Injuries
If a claim for a disability leave under the JPMorgan Chase Disability Leave Policy for a non-occupational illness or injury is denied, either in whole or in part, you can appeal the denial by following the appropriate procedures described below.
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You have 180 days from the date of your denial to send a written appeal of the disability leave decision.
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To appeal the disability leave decision, you must send a letter of appeal and medical records, progress notes, test results, and any other applicable medical documentation to the applicable claims evaluator at:
For Employees Working in New Jersey and New York:
The Hartford Group Benefits
JPMorgan Chase Claims Management Team
2599 Lucien Way
Maitland, FL 32751
For Employees Working in All Other States:
JPMorgan Chase
Disability Management Services Appeals Coordinator
131 S. Dearborn
Mail Code: IL1-0708
Chicago, IL 60603
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You may request copies of all documents, records, and other information relevant to your claim; and you may submit written comments, documents, records, and other information relating to your claim.
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The claims evaluator will make a decision no more than 45 days after your appeal is received unless the claims evaluator determines special circumstances exist that require an extension of time to process the appeal. If your appeal requires an extension, a decision will be made no more than 90 days after your appeal is received. The written decision will include specific references to the contract provisions on which the decision is based.
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In the appeal of a claim denial based upon medical judgment, the claims evaluator will consult with an appropriate, independent medical professional. You will have the right to obtain the name of such person if your appeal is denied.
For additional information regarding appealing claims under the Disability Leave Policy, please see the "Plan Administration" section of this Guide.
Occupational Illnesses and Injuries
All claims appeals for occupational illnesses or injuries should be directed to the workers' compensation claims evaluator and/or your appropriate state Workers' Compensation Board or Industrial Commission.
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