Access request: |
when an individual or an individual’s lawyer requests an insurance company to provide them with a copy of the disability claims file |
ACM: |
Abilities Claims Consultant – the individual/claims person/adjuster typically responsible for the adjudication of the LTD file prior to the commencement of litigation |
ADLs: |
activities of daily living |
APS: |
Attending Physician’s Statement |
Call Record: |
an electronic document created to record telephone discussions during the adjudication of a disability claim |
C/B: |
call back |
CHESS: |
an electronic program/database/system where various claims information is located and stored (i.e. policy particulars, benefit amount calculations, payment details) |
COD: |
change of definition - the date the definition of disability changes under the policy |
Commensurate Amount: |
the amount an individual would have to earn in order to satisfy the any occupation test |
DMAP: |
electronic notes entered and recorded by the claims person/adjuster/individual(s) involved in the adjudication of a claim |
DOB: |
Date of birth |
DOC: |
Date of Coverage – the date an employee is eligible to receive coverage under the group policy |
DOD: |
Date of Disability – the date the medical symptoms/condition first prevent the individual from being able to work |
DOH: |
Date of Hire – the date the employee was hired |
DX: |
diagnosis |
EE: |
employee |
EP ends: |
the date employment insurance benefits end |
ER: |
the employer |
ECI: |
salary continuance/STD benefit equivalent |
Elimination Period: |
the period an individual is required to wait before they are eligible to receive benefits under the policy |
ETE: |
education, training and experience |
FAE: |
Functional Abilities Evaluation |
Forecast Date (FD): |
indicates an anticipated/predicted/forecasted claim resolution date (ex. symptoms to resolve, return to work etc.) |
FPD: |
the first date benefits were paid |
FTI: |
functional telephone interview – a telephone interview conducted on behalf of an insurance company, in effort to assess what the individual is able to do/level of function |
FU: |
follow up |
Fund Arrang: |
indicates who is responsible for the payment of benefits (ex. the insurance company or the employer – see also refund and non-refund) |
Government DI: |
group disability policy issued to the Government of Canada |
GP: |
family doctor |
GRTW: |
gradual return to work |
HMC: |
health management consultant – an individual or group that is used by an insurance company for the purpose of rehabilitation |
HP: |
health partner – similar/interchangeable with the term medical consultant |
JD: |
job description |
LDW: |
last day worked – the last day the individual worked |
LMVM: |
left message voice mail |
Max Bnft Period: |
max benefit period – the maximum period for which benefits can be paid under the policy (ex. age 65) |
Medical Consultant: |
a medical professional that is consulted, for the purpose of providing a medical opinion for an insurance company |
MDA Guidelines: |
Medical Disability Advisor guidelines used to reference typical disability recovery periods |
MO: |
medical opinion |
MX: |
medication |
NCQR: |
New Claim Quality Review – an internal review, conducted by an insurance company during the adjudication of an LTD file, for quality control purposes |
Non-Refund: |
the insurance company is responsible for the payment of benefits |
Non-Stand LTD Change of Def: |
a non-standard change of definition applies (i.e. something other than the typical 2 years own occupation test followed by the any occupation test) |
O/P: |
overpayment – an overpayment of disability benefits has resulted |
PM: |
Plan Member – the individual/employee covered under the group plan (i.e. our client) |
PM Code: |
indicates adjudication priority (ex. U = urgent / high priority - for example, recovery or return to work is anticipated in the near future, Opportunity = an opportunity has been identified, for example, to work with the individual toward rehab, recovery and ultimately a return to work) |
Pre x: |
Pre-existing medical condition(s) |
PS: |
Plan Sponsor – the employer / holder of the group policy |
PX: |
prognosis / expected period for recovery |
QD: |
Qualifying Date - the earliest date LTD benefits are eligible to be received if approved |
R&L's: |
restrictions and limitations |
Recovery Score: |
a numerical score assigned to indicate an anticipated/forecasted/predicted likelihood of the LTD claim being resolved either by way of a return to work or some other form of resolution/settlement |
Refund: |
the employer will ultimately be responsible for the payment of benefits |
RTW: |
return to work |
SDCC: |
Senior Disability Claims Consultant – an LTD claims individual/adjuster typically assigned carriage of an LTD file once litigation has been commenced |
SLC: |
salary continuance |
SX: |
symptoms |
Team Leader/Manager: |
an individual at an insurance company that a claims consultant/ACM/adjuster reports to |
TDAO: |
Totally Disabled Any Occupation |
TDOO: |
Totally Disabled Own Occupation |
TSA: |
Transferrable Skills Analysis – an analysis/report prepared to identify an individual’s education, training and experience that could potentially be applied toward securing an alternative occupation |
TX: |
treatment |
Ultera: |
an electronic document storage system |