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TOP 6 REFRESHER TRAINING
GLOBE CLAIMS
REFRESHER TRAINING
Death Notifications
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NOTIFICATION OF DEATH
Death Notifications
The Death Notification initiates the claim process and these calls should be handled extra sensitive.
All death notification calls should NEVER be rushed and we MUST make sure our
customers are well informed of all company processes surrounding the death
notification and the entire claims process.
N.O.D.
You are required to state one of the
following scripts at the beginning of every
death notification.
“Please accept my condolences on your loss!”
“I’m sorry for your loss!”
What information to get from the caller?
What information do I get from the caller?
Below is a list of items you will be required to get from the caller when providing a notification of death.
- Caller's name
- Relationship to the insured
- Telephone Number
- Date of Death
- Cause of Death
- Name and Address of Caller/Beneficiary
- Any additional notes from the caller
What information to give to the caller?
What information do I provide the caller with?
The following information should be reviewed BEFORE releasing any information to the caller:
Review the notes to determine if the death has previously been reported, check for recent changes, reinstatement dates, and rider effective dates to determine policy contestability.
Review the Status and Paid to Dates to confirm the policy was ACTIVE at the time of death.
Review the Effective date, EC code. If the policy has been reinstated the first position of the EC code will be a “D”.
Review the Death Benefit and check for any outstanding loans on the policy.
Review all Primary Beneficiaries listed on the policy to notify the caller or funeral home during the death notification call to ensure no issues arise when assigning benefits with a funeral home.
Once all of the above information has been reviewed, you can release this information to the caller when taking the death notification call.
**However, you CANNOT release this information to Funeral Funding Companies.**
Standards
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Scripting
Mandatory Scripting
The following script is now mandatory and must be read anytime you receive a Death Notification call for a policy within the Contestability Period:
“Because this policy is less than two years old, or has been reinstated within the last two years, this claim is considered Contestable. That means we will be sending you claim forms to complete. Based upon the information provided by you, claims analysts will need to collect medical records to ensure that all medical questions asked in the policy application process were answered correctly. We cannot give you an anticipated completion date as the length of time required to examine the claim will depend upon the timely receipt of the completed claim forms and the collection all corresponding medical records. In many cases, the collection of such records can take several weeks, depending upon the responsiveness of medical providers.”
Standards
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Funeral Funding Procedures
Funeral Home Procedures
If a Funeral Funding Company has a "re-assignment" attached to the policy, we can ONLY provide them with claims STATUS.
If a funeral home as an "assignment" on the policy that has been received and logged into the notes, we can release any of the following when providing claims status.
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However, we CANNOT release the following information over the phone:
- Benefit Amount
- Beneficiary Information
- Outstanding Loans
- Certified Death Certificate (Received)
- Claim Forms (L41) (Received)
- Affidavits (Received)
- Requested Medical Records (Received)
- Any outstanding items on the Claims checklist
- Beneficiary information
FUNERAL HOMES
Please make sure you check OnBase
Assignment vs. Re-assignment
Please be very careful when determining which one we have received.
Claims Documentation
There are multiple places where documentation can be seen as received, but they are stored in one place; OnBase.
Please be sure you are checking both OnBase and the notes to verify we have received all of the requested documents.
The documentation needed will vary depending on the type of claim being either "contestable" or "incontestable".
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VERIFYING DOCUMENTATION
Incontestable Claims
Incontestable Claims
If you see the above claims status, confirm in OnBase if we have received the Certified Death Certificate and Obituary. If not, ask the caller if they have mailed it for consideration.
If they HAVE NOT submitted their information the claim status is apparent, recite the below scripting: “In order to consider the claim we will need to first receive the requested information in regards to the insured from you.”
If they HAVE submitted their information, ask them when did they mail it. Then recite the following scripting based on their mailing date: “Please allow up to 15 business days from the date you mailed the information for the company to receive and log your claim information into the system. Please allow up to 3 business weeks to consider your claim.”
Contestable Claims
Contestable Claims
All of the following must be on file in order for us to complete a contestable claim.
- Completed Claimant’s Statement
- Completed Authorization for Release of Medical Records
- Completed Attending Physician’s Statement
- Certified Death Certificate
- Police Report (Accident, Homicide, or Suicide)
- Copy of Obituary (if available)
- Copy of Newspaper Article (Homicide)
- Executorship Papers may also be necessary in order to obtain certain medical records. Please provide them if they are available.
Contestable Claims have no time frame due to the dependency of medical providers and the documentation requested from the beneficiary.
Authorization To Release Health Information
The authorization for release of Health information pursuant to HIPAA is necessary for Medical Providers to release medical information to the Company to complete the claim.
The HIPAA statement needs to be signed by the Beneficiary, Next of Kin, or Executor of the Estate.
Authorization to Release Health Information
Statement of Physician (APS)
The attending physician statement needs to be completed by the attending physician. If the insured only went to clinics, the last clinic physician needs to complete the form.
If the beneficiary returns the form blank, or does not return it at all due to not physician the claim will be suspended.
If there is no physician for the insured the beneficiary must submit a statement in writing to the Claims department.
Claimant's Statement (CS)
Claimant's Statement
The Claimant's Statement needs to be filled out by the beneficiary or beneficiaries on the policy.
If the beneficiary of the policy predeceased the insured, a copy of the beneficiary’s death certificate must also be attached. At this time the Claimant’s Statement would need to be completed by the Executor of Estate or Next of Kin if an Executor of Estate has not been designated.
Claims may require Executorship paperwork from the Next of Kin.
Affidavits and Procedures
Affidavits
An affidavit is a sworn statement made voluntarily in writing. The party giving the written statement declares the facts stated are true and confirms this under oath. It must be signed before an officer who is empowered to administer such oaths.
We are no longer able to provide our caller's with which affidavit needs to be sent in.
However, all affidavits need to be signed by a judge or notarized and reviewed by our Legal department before being deemed as sufficient.
Please make sure you advise your caller to check with their County Clerk, Probate court, or to obtain legal counsel.
Accidental Death Benefits
There will be times where the base policy is incontestable, but that DOES NOT mean that the Accidental Death Benefit is also.
All ADBs attached to the policy are considered contestable and will need Claim forms to be filled out and sent back to us.
Also remember, contestable policies and/or riders have no timeframe due to the dependency of our medical providers.
ADBs
Determining Claims Status
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In order to determine whether or not a claim has been completed, you will need to check a few of the following fields in CMPD.
TYPE
AMOUNT
CHECK
DT-PAID
CLAIMS STATUS
Reading CMPD in eService
CLAIMS STATUS = CMPD (SCREEN 19)
CMPD is our primary option for determining whether or not a claim has been paid.
TYPE: If a check has been issued the type field will have the word “Pay” in it. PAY is a valid pay type. If anything such as REJ, STOP, HIST, or PEND is listed, the claim has not been paid.
AMOUNT: This dollar amount must be a valid FACE amount. $.01 is not a valid FACE amount, neither is $456.72. this is a good indication of premiums being returned to the Beneficiary.
CHECK: Notice the check number listed in the example, this is a valid check number. There are times when the check number is listed as “00000001” and this is not a valid check number.
Claim Completed
Claim Completed???
You may see a check issued in CMPD, but that does not always mean the claim has been completed. You will also need to make sure the entire benefit amount has been accounted for.
In the example shown you can verify that we have a valid pay type, paid face amount, check number, and a valid date in DT-Paid.
Reading CMPD in Mainframe
CLAIMS STATUS = CMPD (SCREEN 19)
CMPD is our primary option for determining whether or not a claim has been paid.
TYPE
Certified Death Certificates
A "certified" copy of the death is required for us to begin the claims process. If the benefit amount of the policy 15K and under, the death certificate can be faxed to us.
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READING CDCs
Viewing Certified Death Certificates
Please remember to check the following when verifying whether or not we have received the proper CDC:
Name of the deceased
Date/Time of Death
Date of Birth
Cause and Manner of Death
Viewing CDCs
Warm-up
activity
Warm-up activity
Step 1
AI Records
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AIRecords is a division of our sister company, American Income Life Insurance.
AIRecords is the division that requests all medical providers during a Contestable Review to verify if the information on the application was true when it was completed.
If a beneficiary or funeral home is calling in regards to claim status, you can actually view the communication between our company and the medical providers to determine a status for the records and ultimately the claim.
AI Records
Logging into AI Records
Logging Into AI Records
To log into AI Records, you would first need to access the following weblink:
https://prodwebapps.ailife.com/APSWeb/login.aspx
Once you have accessed the weblink, you will be prompted to log in with our username and password. These will be provided to you shortly.
Username: globe
Password: globelife1
Viewing Record Status
Viewing Record Status in AI Records
Provider Information
Case Status
Once you've typed in the policy number, all of the associated provider information will show.
Click Select to view the transactions of each provider
Reviewing Information from Providers
Once you select a provider you will need to review the Doctor Information to ensure you are looking at the correct provider.
Review the Case History to see the last transactions performed on the policy.
MSGLs for Claims
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Before sending an MSGL to Claims for status, make sure you check all of the following areas:
Mainframe (CCLT, CMDI, CMPD)
OnBase (Claim Record & Checklist)
Notes on the policy
AI Records
MSGLs (To see if one has been sent)
MSGLS
GCLL
GCLL (Claims)
Most Common MSGLs
Most Common MSGLs Used For Claims
001 CLAIM STATUS - primarily used to check the status of the Claim when all documentation has been received and we are outside the time frame for completion.
003 STATUS OF REISSUE OF CHECK - ONLY to be used in cases where a claims/refund check has been re-issued and 30 days has passed without it being received.
007 RESEND LETTER - Used in cases where the beneficiary/owner has not received the documentation that was sent to them.
008 REMOVE DEATH STATUS - To be used in cases where the policy was incorrectly placed in a death status.
010 STOP PAY AND REISSUE CHECK - ONLY to be used in cases where 30 days has passed without a claims or refund check being received. Also used in cases where "company error" caused the address to be incorrect.
013 MEDICAL RECORDS ADDRESS UPDATE - Used when we receive updated information in regards to requested medical documentation/information.
015 NOTIFICATION OF DEATH - Can be used to process a death notification if the policy does not pull up in eService or Mainframe.
017 FORM 712 REQUEST - Used when we
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LEAVING NOTES
Leaving Notes
It is very important that notes are left on each Claims call. There is no instance where you would not leave notes.
Keep in mind, these claims can take weeks and sometimes months to fully complete, so any information that can be provided to help the next representative would be very beneficial.