1. How do I report a disability?
2. How do I know if I am disabled?
3. Do I need to wait 14 days before reporting a disability?
4. What information will I be expected to provide when I call Concordia Plan Services about a disability?
5. Is a Medical Authorization Form required?
6. Can I call Concordia Plan Services in advance to report a disability?
7. How long should I expect to wait before my first contact by Aetna?
8. What happens to my claim after it goes to Aetna?
9. Who decides that I am disabled and eligible for a benefit? How much is my doctor involved?
10. How long will Aetna typically approve a benefit?
11. Where do the benefit payments come from?
12. What are my options if my claim is denied by Aetna?
13. How does Aetna handle an appeal?
14. Is there a possibility that Aetna might discontinue my benefit before my doctor releases me to return to work?
15. Aetna has notified me that I need to contact my doctor to get medical information. Why is that my responsibility?
16. Would I be able to return to work part-time, and continue to receive a benefit, after being totally disabled but before I was allowed to return to my full-time job?
17. Is it acceptable for my employer to supplement the 70% disability benefit paid to me by the Concordia Plan Services?
18. Are my benefits taxable?
19. Who do I call if I have questions?
20. When should I apply for Social Security disability?
21. How does submitting a disability claim affect my other Concordia benefits?

All it takes to start the process is a telephone call. When you are sick or injured, and it appears that you will be unable to work for at least two weeks, you, a family member, or a representative of your employer should call (as soon as possible) the Concordia Plan Services’ office toll-free at 888-927-7526. Initial information will be secured from the caller by Concordia Plan Services disability support staff and forwarded by fax or e-mail to Aetna. Further contact will be made by Aetna by telephone to the physician and to you or your representative to secure the additional information needed to determine eligibility for benefits. There is no application form that needs to be completed to apply for disability benefits.

CDSP defines disability fairly broadly according to the following:

• You must be absent from work for a period of 14 consecutive days and must be under the regular care of a licensed medical doctor. Your doctor(s) must provide documented, objective, medical evidence of the disabling condition.
• During the first two years of disability you must be unable to perform the essential duties of your occupation because of a medically supported physical or mental condition, or be unable to earn at least 80% of the compensation you were earning prior to the onset of a medically established physical or mental condition.
• After the first two years of disability, you must be unable to engage in any substantial, gainful activity for which you are qualified by training, education, or experience because of a medically established physical or mental condition.

While pregnancy is considered a disabling condition, impairments that are not eligible include those that result from an injury or illness sustained while serving in the armed forces, committing a crime, or willfully and illegally participating in a fight, riot, or civil insurrection.

No, you are encouraged to call the CPS office as soon as you feel reasonably certain that your illness or injury is going to keep you out of work for more than the 14 calendar days. Any claim for disability benefits under the plan must be submitted as soon as is reasonably practicable but in any event, not later than ninety (90) days after the disability began. Aetna will use information from your doctor to determine if you satisfy this part of the disability definition. (See Question #6)

Your name, address and phone number, your Social Security Number, your last day at work, the first full day you were unable to work, your work phone number, the nature of your condition, your employer’s phone number/contact information, and your doctor’s name and phone number. (It would be helpful, when leaving the information, to spell the member’s and doctors last names.) If someone is calling on your behalf, he or she will need to provide the same information. Note that Aetna will not accept a claim intake directly from a member. You must first call Concordia Plan Services.

Yes, you will be asked to complete an authorization form, which allows medical information to be released to Aetna. The form will be mailed to you by Aetna or after speaking to Aetna, if you have a doctor’s appointment scheduled soon, Aetna will fax the Medical Authorization Form to your doctor’s office for you to sign.

Can I call Concordia Plan Services in advance to report a disability?

No. You should call the Concordia Plan Services office only when you can report the last day worked. This means that you will normally already be off work due to a potentially disabling condition even though you may not have satisfied the 14-day waiting period.

Although a Aetna case manager will normally call you within 2 days of case assignment, it is best to allow up to a week for the first contact. Please call the Concordia Plan Services office if you have not received the initial contact by Aetna within that time. At the time of the first Aetna contact, you should be given the name of the Case Manager along with a toll-free number, so you can get in touch with the Case Manager directly, if necessary.

The initial intake information goes first through a Aetna Intake Coordinator, and then is sent to a Senior Nurse Reviewer for evaluation of the medical and treatment data currently available. The Reviewer then makes the assignment to an appropriate Case Manager and also makes periodic reviews of all claims of longer duration. Regular updates are procurded at various levels to ensure appropriate claim/medical management. Throughout the process, evaluations are performed in consultation with peer advisors (MD Specialists) when necessary.

After the Aetna Senior Nurse Reviewer evaluates the initial information about your condition, each claim is assigned to a Case Manager, who makes the necessary contacts with you and your doctor, to gather information about your medical condition and the nature of your job responsibilities and work environment. In most cases, it is the Case Manager who makes the initial decision to grant or deny a benefit. However, this is only after evaluating as much information from your doctor as can be acquired.

That depends on the nature of the disabling condition and the information supplied by your treating physician. However, normally the first approval period (and possibly some of the subsequent approvals) will be for a fairly short period, typically until the next appointment with the doctor. If updated medical information provided from that latest appointment confirms your continued disability, Aetna will be able to extend the benefit payment for another period until a later doctor appointment. If the disability continues for a longer period, the approval periods will also be extended and may not be so dependent on the next doctor’s appointment. It is important to remember that just because Aetna approves a benefit for a specific time period; it does not automatically mean that no further benefits are available. But, there could be a delay in receiving additional benefits if there is a delay in receiving up-to-date medical information from the treating physician. (See Question #15)

After Aetna confirms that you are disabled, the Concordia Plan Services office is notified of the beginning and ending dates for payment of benefits (the ending date is subject to extension as described here). The benefit checks are then processed and mailed from the Concordia Plan Services office, with the monthly amount equivalent to 70% of your monthly salary in effect at the time the disability began.

If the Case Manager determines that you are not or are no longer disabled, the decision is reviewed by a Aetna supervisor. The supervisor may also make the final decision or implement a Peer Review process if appropriate. If the denial decision is upheld, you are notified by telephone, followed by written confirmation. The letter to you will include the medical reasons for the decision and explain your right to appeal. A description of the information that should be provided to Aetna for re-consideration is also included. A formal letter of appeal may be submitted to Aetna, and if that results in a second denial, another letter is sent with the same type of information as the initial denial letter, also offering the option of a second level appeal where any new information may again be submitted for consideration. If you continue to be dissatisfied with the second level appeal decision you have the right to appeal to the Board of Managers who will further consider your claim. The method of appealing to the Board will be included in your second level appeal denial letter and is also described in your CDSP Summary Plan Description.

Please note that to maintain a member’s privacy, Aetna does not share detailed medical information with the Concordia Plan Services office. Only general information, necessary to administer the plan, is provided to selected members of the Concordia Plan Services staff.

When an appeal letter is received by Aetna, it is forwarded to the Appeals Coordinator, who is part of a unit of Aetna that is totally separate from the regular disability processing function. A letter is sent to you within 2 business days acknowledging receipt of the appeal. All information available, including any new medical records, treatment notes, or therapy details submitted with your appeal, are reviewed and, if applicable, discussed with a Aetna Peer Advisor (a staff MD with an appropriate specialty). The Appeals Coordinator makes a decision on the appeal within 45 days of receipt of the appeal letter. You will be given written notice of the decision, with an appropriate explanation.

Yes, there may be occasions when that could happen. Benefits are granted when there is sufficient medical information to demonstrate your inability to perform the essential functions of your job or earn at least 80% of your compensation. When all available information relative to your medical or psychological impairment, its ongoing treatment, therapy and aggressive plan is evaluated, it is possible that Aetna may decide that you are not so seriously impaired that you are not able to perform any kind of work. The goal of Concordia Plan Services, through Aetna, is to help you return to some form of gainful employment, most preferably with your present employer, or at least within the Synod. However, in certain cases, you might be required to accept a different type of position than the one you previously held.

Following receipt of your initial intake information, and whenever further details or clarification are needed, Aetna will attempt to contact your doctor. If they are not able to reach the doctor after 3 attempts in a 14 day period, they may deny benefits because of possible incomplete information. However, Aetna recognizes that some additional information may provide justification for authorizing benefits. Therefore, believing that you as the patient should have more influence with the doctor’s office to get the needed information, and are the one to benefit directly by Aetna’s receipt of medical updates, you are asked to exert your influence to get the doctor to respond to Aetna’s request.

Yes, it is very desirable to have disabled workers return to productive employment as soon as medically possible. With your doctor’s permission, a partial return to work might be appropriate as healing takes place, allowing you increased strength for greater activity. There might also be a work phase as part of a professionally developed rehabilitation plan, intended to help you get back into the job stream. In either case, the normal benefit for total disability would be offset by 70% of the income earned from your partially returning to work. It is important to notify Concordia Plan Services of part-time earnings so your benefit amount can be accurately calculated and paid.

Yes, some employers are willing to pay a portion or all of the difference between a worker’s regular salary and the 70% benefits amount, often for a specified period of time, i.e. the first 26 weeks (or six (6) months) of disability. This may be especially important if the normal salary amount for a worker is low to begin with. However, any type and amount of salary continuation provided by the member’s employer during the disability will be reduced, beginning after the first six (6) months of such salary continuation payments.

Disability benefit payments are subject to federal income tax. However, Concordia Plan Services is not required to nor does it withhold federal income tax from a lay worker’s disability payments unless the worker has provided the Concordia Plan Services office with a completed Federal W-4S, Request for Federal Income Tax Withholding from Sick Pay. This form is available from the Concordia Plan Services office, or it can be downloaded from the IRS website www.irs.gov.

Disability benefits paid by the CDSP to a minister of the Gospel will be designated as “housing allowance”. This means that a disabled minister can exclude up to 100 percent of the disability benefits received from federal taxable income, to the extent that it is used to rent or provide a home (excluded may not exceed the annual fair rental value of the home, furnished plus utilities). Qualified expenses include rent (if housing is rented) or principal and interest payments and real estate taxes (if a home is owned), as well as expenses for utilities, routine repair and maintenance, capital improvements, furnishings and garage rent.

Any disability benefits you receive during the first six months following the last calendar month in which you worked are also subject to Social Security and Medicare taxes. After that, your disability benefits are exempt from Social Security and Medicare taxes.

• With respect to those workers who are not considered self-employed for Social Security purposes, Concordia Plan Services will withhold the worker’s portion of Social Security and Medicare taxes from each disability payment made during the six month period described above. CDSP will also pay the required employer portion of Social Security and Medicare taxes on your behalf.
• Those workers considered self-employed for Social Security purposes will be required to pay self employment taxes for the disability benefits received during the first six months following the last calendar month in which they worked.

If you are not a rostered, ordained or commissioned Minister of Religion, Concordia Plan Services will report the disability benefits to the IRS each year and will issue you a W-2 form by January 31 reporting the disability benefits paid during the prior year. If you are a rostered, ordained or commissioned Minister of Religion, Concordia Plan Services will send you a letter by January 31 each year reporting the total amount of disability benefits paid during the prior year as well as information regarding eligibility on the housing allowance.

The Concordia Plan Services’ disability support staff is always available to answer questions and help you through the process, even after the initial reporting. However, for specific information about your disability status, the length of your benefit approval, the impact your medical condition might have on your eligibility for benefits, or other issues that you may wish to pursue involving your benefit approval or denial, it is best to contact the Aetna Case Manager assigned to you.

IIf your disability has continued for six (6) months, and it is expected that it will continue for at least a year, Aetna will contact you in or about the sixth month and mail you a packet of information that will explain the service of Allsup, Inc. Allsup is a company that will assist you in obtaining Social Security disability benefits. This service is supplied at no cost to you, the worker. The disability benefit that is paid through the CDSP is offset by Social Security disability benefits. If you do not participate in Social Security your CDSP benefit will be offset by the estimated amount of Social Security disability benefits you would have reserved if you were participating in Social Security as outlined in the Plan Provisions, Section IV, 4.2,e) and f).

Your health benefits under Concordia Health Plan (CHP) benefits, (if applicable) enrollment in the Concordia Retirement Plan (CRP), life insurance under the Concordia Disability and Survivor Plan (CDSP), enrollment in the Concordia Retirement Savings Plan (CRSP) (if applicable), and coverage under the Accidental Insurance Program (AIP) will be administered as follows due to your application for disability:

CONCORDIA RETIREMENT PLAN (CRP):
If the claim is approved, your membership in the CRP will continue as though you are an active member with all applicable waivers of employer contributions. If the disability claim is denied, your coverage under the plan terminates at the end of the calendar month in which your claim is denied; unless you have returned to work by that date.

Your membership would be reinstated at the time the disability claim is approved via the appeal process or upon a finding of continued disability via the appeal process and would include the time period the 1st Line Appeal was being processed and reviewed.

ACCIDENT INSURANCE PROGRAM (AIP):
If you were participating in the Accident Insurance Program (AIP), participation must terminate following your last active date of employment because only those employed on an active, full-time basis are eligible to participate. When you have recovered and returned to work on an active, full-time basis, coverage will automatically be reinstated on the first of the following month unless you supply written notice to the contrary.