Claims are adjudicated promptly with minimal disruption to claimants. There may be circumstances in which a claim may require an investigation or further information such as:
- Police reports
- Autopsy reports
- Medical reports/records
- Individual information from the beneficiary, employer or witnesses
- Examination/interview by an independent medical physician
- Certified copies of birth certificates or marriage licenses
- Affidavits such as of survivorship
- Tax information or documentation showing support for dependents
If additional information is required to process your claim, your assigned claims examiner will contact you by phone or written correspondence. Once the claim has been processed, you will receive an Explanation of Benefits (EOB) that explains how your claim was processed. This document contains important information about your claim, including the status. Please retain it for your records. If the claim has been denied, please refer to the Remark Code section for an explanation. It may be that all that is needed is additional information to move the claim forward.