Voluntary Long-Term Disability (VLTD) Insurance

Claim Form:

1. You may download the Voluntary Long-Term Disability Claim Form or you may call (800) 877-5176 to request the VLTD claim form. Instructions on how to file the form are included in this document.
   
   
2. Please complete the Employee Portion of the claim form in its entirety.
   
   
3. Also complete and sign the Authorization to Disclose Personal Information. This will allow the insurance carrier to secure additional information (if necessary) to make a decision on your request for benefit payments.
   
   
4. You will need to give the Employer portion of the claim form to your Postal Supervisor or Postmaster to complete.
   
   
5. Once complete, return to the address or fax number on the claim form.
   
   
6. You will also need to give a copy of the signed Authorization to Disclose Personal Information to the primary physician treating you along with the Attending Physician Statement (APS). Instruct your attending physician to send the completed APS to Mutual of Omaha.
   
   
7. Once all information is received by Mutual of Omaha, they will advise you of your eligibility for benefits or of any additional information needed.

Follow up:

1. There may be a delay in processing your LTD claim due to missing information (i.e. medical records, Attending Physician Statement, Authorization to Disclose Personal Information, verification of information, etc.).
   
   
2. Mutual of Omaha will follow up on missing physician information until it is received. If Mutual of Omaha does not receive a timely response form the physician’s office, Mutual of Omaha may recommend that you contact your physician’s office in order to expedite the request.
   
   
3. Medical records may be a very important factor in reviewing your claim for disability. Depending upon your injury or illness, Mutual of Omaha may require medical records in order to make a claim decision.
   
   
4. Benefits will be determined based on the information received by Mutual of Omaha. If your physician’s out-of-work request indicates that your duration for disability is longer than “Standard Duration Guidelines”, we will request medical records to support additional benefits.

For any assistance in completing the claim form, please call Disability Customer Service at (800) 877-5176.

Voluntary Term Life (VTL) Insurance
How to file a Life Claim with Mutual of Omaha (PDF version)

1. Download the Proof of Death (Life Claim) Form. Instructions on how to file a claim are included in this document.
   
   
2. The Beneficiary or other claimant should complete both Part II and the Authorization to Disclose Personal Information sections of the form. An original certified Death Certificate should be attached to the form and returned to the Policyholder or Group Administrator (This would be the Postmaster or Postal Supervisor of the Insured).
   
   
3. The Policyholder or Group Administrator (This would be the Postmaster or Postal Supervisor of the Insured) should complete Part I.
   
   IMPORTANT: Employers MUST attach the original enrollment form/records plus any beneficiary changes to the Proof of Death form. If a dependent has a claim, you must attach a photocopy of the employee's original enrollment form to the Proof of Death form.
   
   
4. If any beneficiary, other than a contingent beneficiary, died before the Insured, a copy of the Death Certificate of such beneficiary must be attached to the proofs. In such case, a claim should be made by the other beneficiaries, or if there are none, by the duly appointed representative of the Insured’s estate.
   
   
5. If a claim is made on behalf of the estate of the deceased, a certified copy of the
   Letters of Administration must be attached to the proofs.
   
   
6. If any beneficiary is a minor or legally incompetent, a certified copy of the Appointment of a Guardian must be attached to the proofs.
   
   
7. Return completed form to:
   
   United of Omaha Life Insurance Company
   Group Life Claims
   Mutual of Omaha Plaza
   Omaha, NE 68175-0001
   
   
8. Upon receipt of the completed claim form and required proofs, the claim will be submitted for processing.

Please call (800) 775-8805 if you have additional questions or need further assistance.