Claim Filing Instructions
Income Continuation Insurance (ICI) and
Long-Term Disability Insurance (LTDI) Plans
An Income Continuation Insurance (ICI) or Long-Term Disability Insurance (LTDI) claim may be filed over the telephone with Aetna (formerly Broadspire).
An employee who is applying for LTDI benefits must still contact Employee Trust Funds (ETF) toll free at 1-877-533-5020 for an LTDI estimate or a claim form if the employee wishes to file a paper claim instead of filing electronically.
How to file a claim:
- Employee calls Aetna (formerly Broadspire) at 1-800-960-0052 to file an ICI and/or LTDI claim.
- Aetna customer service representative collects basic information including name, Social Security number, date of birth and current mailing address.
- Aetna will ask questions related to absence, such as: employee and employer location, the nature of the disability, last day worked, the name, address and telephone number of attending and/or treating physicians, and any additional work-related information.
- Aetna mails an introductory packet to the employee. This packet includes a medical release form and a letter to be given to attending physician.
- The introductory letter explains how the program works and what to expect while the claim is pending.
- The medical release form must be signed and returned to Aetna or to the claimant's attending and/or treating physician immediately. Note: The attending and/or treating physician's, clinic or medical records departments may not release confidential medical information to Aetna without the claimant's consent. Aetna cannot continue processing the claim until the medical release form is received.
For ICI Claims
- An Aetna registered nurse will contact the attending and/or treating physicians to obtain clinical information concerning the claimant's disability.
- The nurse may call the physician to arrange a return to work plan for the claimant. The plan may include modified hours or restricted duties. Aetna will contact the employer to determine if job modifications can be made. Written correspondence is sent from Aetna regarding any determinations made on the claim.
- Aetna contacts the physician for an ongoing review of the disability claim to obtain updates on the diagnosis, symptoms, treatment and return to work plan.
- Prior to a return to work date, Aetna may call to confirm the return to work plans if, at the last medical update, the physician did not indicate the possibility of an extension of the claim.
For LTDI Claims
- The physician is required to complete the ETF disability medical report form (ET-5303 or ET-5338) as required by Wisconsin Administrative Code ETF 50.48 (2).
Direct questions pertaining to benefit plan requirements, claim status, etc., to Aetna (formerly Broadspire) at 1-800-960-0052. Aetna representatives are available from 7:45 a.m. to 4:30 p.m. central time, Monday through Friday, except State holidays. Callers may leave voice mail messages 24 hours per day, 7 days per week.
ET-5106