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Things
to Know |
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Any member or former member
may submit a claim for LTD.
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If a member becomes disabled
on or after July 1, 2005, his/her waiver
of premiums will stop when the member is
eligible for normal retirement.
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If the member’s employment
is being terminated because of a disability,
please complete a Termination
of Employment form. The form is
available in electronic format.
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LTD benefits are not available
to members eligible for normal retirement.
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Before LTD benefits may
be paid, the member must complete the 90-day
benefit waiting period or exhaust sick leave,
whichever is later.
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No department may take any
action that prohibits a member or former
member from submitting a claim.
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A termination for cause
would not prohibit submission of an LTD
claim.
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For detailed information
regarding the MOSERS LTD plan through Standard
Insurance Company, please refer to the Long-Term
Disability Handbook.
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To
Apply for LTD Benefits |
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- To apply for LTD benefits, the member must
submit the following forms to Standard Insurance
Company:
- Member’s Statement
(completed by member)
- Attending Physician’s Statement
(completed by physician)
- Employer’s Statement
(completed by employer)
- Authorization to Obtain Information
(completed by member)
- MOSERS will notify you and the member when
a determination of disability is made by Standard.
- If the member has MOSERS life insurance
coverage, the member is automatically evaluated
for waiver of premium by completing the LTD
application.
- Waiver of premium benefits are not available
to members age 60 and over or eligible to
retire.
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The LTD form is a 9-page packet. You are responsible
for filling out the front and back of the Employer's
Statement.
Mail the completed form and the required attachments
to Standard Insurance Company in the envelope provided.
Standard Insurance Company
Group LTD Benefits
PO Box 2800
Portland, OR 97208-9929
(800) 378-4577
Group Policy Number: 604201-B
Example of Employer's Statement below:
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