Human Resources » Benefits & Retirement » Long Term Disability » Filing A Claim

Long Term Disability: Filing a Claim

You must give us written notice of a claim  within 30 days after Disability starts or as soon as possible.  Please contact your campus HR office or Benefits and Retirement for the forms to complete.

Proof of Loss may include but is not limited to the following:
1. documentation of:
a) the date your Disability began;
b) the cause of your Disability;
c) the prognosis of your Disability;
d) your Earnings or income, including but not limited to copies of your filed and signed federal and state tax
returns; and
e) evidence that you are under the Regular Care of a Physician;
2. any and all medical information, including x-ray films and photocopies of medical records, including histories,
physical, mental or diagnostic examinations and treatment notes;
3. the names and addresses of all:
a) Physicians and practitioners of healing arts you have seen or consulted;
b) hospitals or other medical facilities in which you have been seen or treated; and
c) pharmacies which have filled your prescriptions within the past three years;
4. your signed authorization for us to obtain and release:
a) medical, employment and financial information; and
b) any other information we may reasonably require;
5. your signed statement identifying all Other Income Benefits; and
6. proof that you and your dependents have applied for all Other Income Benefits which are available.
All proof submitted must be satisfactory to the insuring company.

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Campus/Institute Contacts:
Family Practice- Chatt. 
Health Science Center  
Knoxville Area    
UT Memorial Hospital

Deferred Compensation (401k, 457, 403b) Forms:
     Total Rewards/ Benefits & Retirement Office
     600 Henley St, #115
     Knoxville, TN  37996-4115

Insurance Forms:
     Insurance & Retirement
     P115 Andy Holt Tower
     1331 Circle Park
     Knoxville, TN  37996-0100

Retirement Forms:
     Total Rewards/ Benefits & Retirement Office
     600 Henley St, #115
     Knoxville, TN  37996-4115

Other Links:
Deferred Compensation (State site)
Deferred Compensation (Empower Retirement site)
Optional Retirement Program (ORP State site)
Tennessee Consolidated Retirement System (TCRS State site)
Office of Personnel Management- OPM (CSRS & FERS)