Life, Accidental Death & Dismemberment and Disability Claims

Life Claims
Procedure for Submitting Life Claims:

1. Complete and sign the Administrator's or Employer's Statement section on the Proof of Death Claim Form. The beneficiary(s) must complete and sign the Beneficiary's Statement.
2. Submit the Proof of Death Form to the address on the top of the form with a certified copy of the final death certificate. Also provide a copy of the insured employee's Group Enrollment Form and, if applicable, the Beneficiary Change Form to your Trustmark Claims Office.
3. We will contact you, if any additional information is required.

Waiver of Premium
A member, who becomes totally and permanently disabled, may qualify for continued life insurance coverage without payment of premium. In order for the member to qualify, the following criteria must be met:

• Disability must begin before age 60.
• Disability must begin before retirement.
• The member must be eligible for the Life Benefit.
• Member must have been disabled for nine months from the date last worked.
• Proof of permanent disability from any occupation must be furnished to the Company after nine months and before one year from the date last worked due to disability.

Procedure for Waiving Premium:

1. Complete and sign the employer section of the Group Waiver of Premium/Extended Death Benefit Form. The member's physician must complete and sign the Attending Physician section of the form. If the member has more than one treating physician, give the member additional forms for completion. The member must complete and sign the Authorization for Release of Information section on the back of the Waiver of Premium/Extended Death Benefit Form.
2. The member must send a copy of his or her birth certificate, the group insurance enrollment card and a description of his or her work experience and educational history to:
     Attn: Group Waiver of Premium Department
     Trustmark Group Insurance
     P.O. Box 7948
     Lake Forest, IL 60045-7948
3. All forms must be completed in its entirety to avoid delay in processing.

Accidental Death Claims
Procedure for Submitting Accidental Death Claims:

1. Complete and sign the Administrator’s or Employer’s Statement section on Proof of Death Claim Form. The beneficiary(s) must complete and sign the Beneficiary Statement.
2. Submit the complete Proof of Death Claim Form, a certified copy of the final death certificate and a copy of the accident or police report. If available, please submit a newspaper account of the accident. Also provide a copy of the insured employee’s Group Enrollment Form and if applicable, the Beneficiary Change Form.
3. Review this form for completeness and accuracy and mail to:
     Trustmark Group Insurance
     P.O. Box 7948
     Lake Forest, IL 60045-7948

Accidental Dismemberment Claims
Procedure for Submitting an Accidental Dismemberment Claim:

1. For Accidental Dismemberment, the Proof of Loss of Limb(s) or Sight Statements Forms must be filled out completely. The member must complete and sign Part I and have an eyewitness complete Part II. If no eyewitness was present at the time of the accident, Part II should be completed by the first person to reach the member immediately after the accident. The Group Administrator must complete and sign Part III and the Attending Physician must complete sign Part IV.
2. If available, please submit a newspaper account of the accident or a police report.
3. Review the form for completeness and accuracy and mail to:
     Trustmark Group Insurance
     P.O. Box 7948
     Lake Forest, IL 60045-7948

Short Term Disability Claims
Procedure for Submitting Short Term Disability Claims

1. Complete the Employer section for the Short Term Disability Claim Form.
2. Inform the employee to complete the Employee sections and to have the Attending Physician complete the Attending Physician section.
3. Submit this form to:
     Trustmark Group Insurance
     P.O. Box 7948
     Lake Forest, IL 60045-7948
4. When the employee's return-to-work date is known, please call your Trustmark disability claims office at 800.290.8899.

To avoid delay of disability benefits, do not submit medical bills with disability claims. If any additional information is required, we will contact the Group Administrator.

Long-Term Disability (LTD) Claims
Long Term Disability (LTD) coverage provides monthly benefits to eligible members for periods of extended total disability. These benefits are payable after the elimination period specified in your group policy has passed. Have members refer to their group policy for details about the elimination period, benefit amounts, and length of time for which benefits are payable.

When it appears that one of your covered members will be disabled beyond the end of the elimination period, they should submit a claim as soon as possible. We request that this be submitted one month before the end of the elimination period.

Procedure for Submitting a Long Term Disability Claim

1. Complete and sign the Employer's Report of Claim section on the Group Long Term Disability Claim Form and include a copy of the employee’s job description.
2. The member must complete and sign the Employee's Authorization for Release of Information section of the form.
3. The Attending Physician completes the Attending Physician’s Statement portion of this form.
4. Review the application for completeness and accuracy and mail to the address below. This should be done at least 31 days prior to the date benefits become due. Mail to:
     Trustmark Group Insurance
     P.O. Box 7948
     Lake Forest, IL 60045-7948
   Periodically, additional medical information regarding the disability is necessary. Prompt compliance with our requests for this information will avoid disruption of regular benefit payments.

NOTE: ***Trustmark must receive information about other forms of income such as Social Security, Worker’s Compensation, State Disability Benefits, and any other employer or government-sponsored plans providing disability benefits to the employee, prior to determining LTD benefits.***