Services: Claims

Our claim management resources and tools are recognized throughout the industry for their focus on effective risk management and assisting claimants' efforts to return to work. Our claim representatives, who average five years experience, and our claim managers, who average ten, are committed to delivering outcomes that improve claimants' lives.

CDS offers a wide range of claims services and support to meet your needs:

Claim Administration

  • Complex claims consulting and support
  • Telephonic STD claim intake from employee, employer, and physician (3 point contact)
  • Determine disability according to plan provisions
  • Communicate denied claims to employees with explanation of decision and right to appeal
  • Advice-to-pay reporting or check-cutting
  • Policy and procedural manuals
  • Claims systems and organizational assessment
  • Claims audit of practices and procedures

Claim Management

  • Comprehensive claims processing and adjudication
  • Substantiate medical condition
  • Evaluate prognosis and medical restrictions or limitations
  • Evaluate functional capacity, occupational requirements and alternatives
  • Claim duration review, utilizing on-line clinical guidelines
  • Clinical case management, as appropriate, by registered nurses and physical therapists
  • Monitoring compliance with treatment plans
  • Monitoring for Clinical and Rehabilitation services
  • Monitoring for Social Security Assistance (Allsup referral)
  • Forensic Accounting, as appropriate
  • Recommend additional assessment services such as Independent Medical Exams, Functional Capacity Evaluations, on-site voc rehab/clinical care management
  • Coordinate early-intervention on potential LTD claim
  • LTD disability test change determination
  • Vendor Network

Reporting

  • Client STD/LTD quarterly activity summaries
  • Advice to Pay (ATP) reporting
  • Sick pay reporting
  • Tax reporting
  • Monthly claim reporting: open, new, and terminations

Claim Financial Services

  • Banking arrangements
  • Issuing benefit checks, with the appropriate state and federal tax withholding
  • Tax withholding reporting, employee portion, LTD ER FICA match