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The Boston Mutual Claim Bd 1321 0706 form is a vital document for individuals seeking disability benefits from Boston Mutual Life Insurance Company. This form serves multiple purposes, facilitating the filing of claims while ensuring all necessary information is collected to support the applicant's request. Initially, claimants must fill out the "Employee - Initial Disability Benefits Claim Form," which captures personal details, the nature of the disability, and relevant employment information. Additionally, the form requires input from a treating physician through the "Physician - Initial Disability Claim Form," confirming the medical grounds for the claim. Employers also play a crucial role by completing the "Employer - Initial Claim Form," outlining the employee's employment status and any deductions related to disability premiums. It is imperative that claimants ensure all sections of the forms are fully completed after the onset of disability to prevent delays in processing. Finally, all gathered information must be submitted to the designated address or sent via fax. Understanding the structure and requirements of this form can significantly streamline the claims process, making it essential for both employees and their employers to engage properly in this process.

Boston Mutual Claim Bd 1321 0706 Example

Boston Mutual Life Insurance Company

Group Disability

Claim Filing Instructions

IMPORTANT: All portions of this claim form must be completed after disability begins to avoid undue delay in processing claimant’s request for benefits. If you have any questions when completing this form, please call our:

Toll Free Number - (800) 320-4445

1.Complete "Employee - Initial Disability Benefits Claim Form" in full.

2.Have treating physician complete the "Physician - Initial Disability Claim Form" and return to you.

3.Have Employer complete the "Employer - Initial Claim Form" and return to you.

4.Submit all completed forms to the address below or you may fax all completed forms to our:

Toll Free Fax Number - (888) 594-5729.

Mail To:

Boston Mutual Life Insurance Company

Benefits Administration

P.O. Box 268956

Oklahoma City, OK 73126-8956

BD-1321-0706

Mail to: Boston Mutual Life Insurance Company

Benefits Administration

P.O. Box 268956

Oklahoma City, OK 73126-8956

Toll Free Phone # 1-800-320-4445

Toll Free Fax # 1-888-594-5729

EMPLOYER – INITIAL CLAIM FORM

Employee Name:

Occupation:

Social Security Number:

Hire Date:

STATUS OF EMPLOYMENT: Full Time: ❏

Part Time: ❏

Days per week: ________ Hours per day: _________

 

If employee’s status has changed, please check the appropriate box and provide change date below:

 

 

 

 

Lay Off: ❏

 

Leave of Absence: ❏

 

 

 

 

Terminated: ❏

Retired: ❏

 

PREMIUMS:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Are the employee’s disability premium contributions deducted pre-tax ❏ or post-tax ❏?

 

 

 

 

 

What percentage of the disability premiums do you pay?_________%

 

 

 

 

 

Are Social Security taxes withheld from employee’s pay check? Yes ❏ No ❏

 

 

 

 

 

Date that last disability premiums deducted from payroll:___________ Amount deducted: $__________

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SALARY AT TIME OF DISABILITY:

 

 

 

 

 

 

 

 

 

 

 

Hourly: $_________

Weekly: $__________ Monthly: $__________

 

 

 

 

 

Annually: $__________________

$_____________________

 

 

 

 

 

 

W-2, previous calendar year

Year-to-date, current calendar year

 

 

 

 

 

Date last worked?______________________

 

 

 

 

 

 

 

 

 

 

 

Has employee returned to work? Yes ❏ No ❏ Return date: ________________ Full Time ❏ Part Time ❏

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Is the employee receiving or eligible to receive any of the following?

 

 

Dates Benefits

 

 

Yes

No

Amount

 

Wk

Mo

 

Company Name and Phone Number

 

Begin

End

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Other Group

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Disability

 

❏

❏

$

 

❏

❏

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Salary

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Continuation

 

❏

❏

$

 

❏

❏

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Sick Leave

 

❏

❏

$

 

❏

❏

 

 

 

 

 

 

 

 

PTO/PPT

 

❏

❏

$

 

❏

❏

 

 

 

 

 

 

 

 

Other (Bonus, etc.)

 

❏

❏

$

 

❏

❏

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Retirement/Pension

 

❏

❏

$

 

❏

❏

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Is disability the result of work related injury/illness? Yes ❏ No ❏

 

 

 

 

 

 

 

If yes, has a Workers' Compensation claim been filed? Yes ❏ No ❏

 

 

 

 

 

Please provide name and phone number of Workers' Compensation carrier:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Employer Name:

 

 

 

 

 

 

 

 

 

Office Phone Number:

Fax Phone Number:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Street Address:

 

 

 

 

 

 

 

 

 

City:

State:

 

Zip Code:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Form completed by: (please print)

 

 

 

 

 

 

 

Title:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Signature:

 

 

 

 

 

 

 

 

 

 

Date:

 

 

 

 

 

 

 

 

 

 

 

This documents that the above statements are true and complete to the best of my knowledge.

 

BD-1321-0706

Mail to: Boston Mutual Life Insurance Company

Benefits Administration

P.O. Box 268956

Oklahoma City, OK 73126-8956

Toll Free Phone # 1-800-320-4445

Toll Free Fax # 1-888-594-5729

EMPLOYEE - INITIAL DISABILITY CLAIM FORM

WARNING: Any person who knowingly and with intent to injure, defraud or deceive any insurer files a statement of claim containing any false, incomplete, or misleading information may be guilty of insurance fraud and subject to criminal and civil penalties.

Name:

Social Security Number:

Date of Birth:

Complete Mailing Address:

Complete Resident Address:

Telephone Number:

Do you have dependents under age 18? Yes ❏ No ❏ If yes, please list dependent names and birth dates below:

1)Please list medical condition or injury causing disability:

2)If disability is the result of an accident, please explain where, when, and how accident happened:

3)Is your disability the result of your employment? Yes ❏ No ❏ If yes, please submit copy of Workers' Compensation award or denial letter.

4)Please list all dates of medical treatment pertaining to current disability:

5)Have you ever had or been treated for same or

similar condition? Yes ❏ No ❏ If yes, please explain:

6)Please list name and phone number of treating physician(s):

7)Date Last Worked:

Date Returned to Work:

8)If you have not returned to work, what is the anticipated return date?

❏Full Time: ______________________

❏Part Time:______________________

9)If your request for benefits is approved, do you want Federal Taxes withheld from each benefit check? Yes ❏ No ❏

If yes, please indicate dollar amount below:

(Minimum amount required is $87 per month.) $_______________

10) Please identify other income sources and amounts of income which you are receiving or may be entitled to receive during this disability:

Social Security - Disability ❏ Retirement ❏

Yes ❏

No ❏

$__________

V.A. Benefits

Yes ❏

No ❏

$___________

Dependent Social Security

Yes ❏

No ❏

$__________

Sick Leave or Wage Continuation

Yes ❏

No ❏

$___________

State Disability

Yes ❏

No ❏

$__________

Retirement (normal, early, or disability)

Yes ❏

No ❏

$___________

Other Group Disability Coverage

Yes ❏

No ❏

$__________

 

 

 

 

Include a copy of your award or denial letter from any source that you have received.

AUTHORIZATION TO USE OR DISCLOSE PROTECTED HEALTH INFORMATION

I hereby authorize the entities specified below to disclose any information about my entire medical record and history of treatment for physical and/or emotional illness

to include psychological testing, except psychotherapy notes, to individuals representing Boston Mutual Life Insurance Company (BMLIC) who are involved in determining whether I am eligible for benefits under my insurance coverage. Those so authorized are: a) licensed physicians or medical practitioners; b) hospitals, clinics or medically-related facilities; c) health plans; d) Veteran’s Administration; e) past or present employers; f) pharmacy; g) insurance companies; h) Social Security Administration; i) retirement systems; j) Department of Motor Vehicles, and k) Workers’ Compensation carrier.

NOTICE: Information authorized for release may include information on communicable or venereal diseases such as hepatitis, syphilis, gonorrhea, Human Immunodeficiency Virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS) or other conditions for which you may have been treated. This authorization excludes disclosure of the result of a test for HIV if you have tested HIV positive but have not developed symptoms of the disease AIDS. Such test results shall not be discovered or published. Nothing in the caveat will prohibit this authorization from including the fact that you have AIDS.

I understand that I may refuse to sign this authorization; however, if I do not sign the authorization, my failure to sign the authorization may result in a denial of benefits. I understand that I may revoke this authorization at any time by writing to Boston Mutual Life Insurance Company, Benefits Administration, P.O. Box 268956, Oklahoma City, Oklahoma 73126-8956 or calling toll free 1-800-320-4445. I understand that my right to revoke this authorization is limited to the extent that BMLIC has taken action in reliance on the authorization; or, the law provides BMLIC with the right to contest my insurance coverage or a claim under my insurance coverage. A copy of this authorization will be as valid as the original. I understand that if protected health information is disclosed to a person or organization that is not required to comply with federal privacy regulations, the information may be re-disclosed and no longer protected by federal privacy regulations.

For health insurance coverage, this authorization will expire twenty-four months from the date it is signed or upon termination of my insurance policy, whichever occurs first. For insurance coverage other than health insurance, this authorization will expire twenty-four months from the date it is signed or upon expiration of my claim for benefits, whichever occurs first. For Arizona residents, release of HIV/AIDS released information can only be disclosed for a period not to exceed 180 days from the date shown below.

Signature :____________________________________________ Print Insured’s/Patient Name: ______________________________________ Date:_______________

Please retain a copy for your personal records, or you may request a copy from our company.

BD-1321-0706

FAILURE TO SIGN & DATE FORM WILL DELAY BENEFITS

Mail to: Boston Mutual Life Insurance Company

Benefits Administration

P.O. Box 268956

Oklahoma City, OK 73126-8956

Toll Free Phone # 1-800-320-4445

Toll Free Fax # 1-888-594-5729

PHYSICIAN - INITIAL DISABILITY CLAIM FORM

Patient’s Name:

Social Security Number:

Date of Birth:

 

Diagnosis: Please list diagnosis resulting in patient’s temporary total disability (including complications)

 

 

Diagnosis: ________________________________________________________________

ICD9 Code: __________________________________

 

 

Diagnosis: ________________________________________________________________

ICD9 Code: __________________________________

 

 

 

 

 

 

 

 

Is disability the direct result of patient’s employment?

Yes ❏ No ❏

 

 

 

 

 

 

 

 

 

 

Is disability the result of a pregnancy? Yes

❏ No ❏

If yes, date pregnancy was diagnosed:

 

 

 

 

 

 

 

 

 

Delivery date: (if delivered)

 

Expected delivery date: (if not delivered)

 

 

History: Was the patient referred to you?

Yes ❏ No ❏ Unknown ❏ If yes, please provide name and phone number of referring physician:

 

 

 

 

 

 

 

Date symptoms first appeared or accident happened?

 

Date patient first consulted you for this condition?

 

 

 

 

 

 

 

 

Are you aware if this patient has ever had the same or similar condition? Yes ❏ No ❏ If yes, please provide explanation including first date of onset.

Treatment: Is patient still under your care? Yes ❏ No ❏ If yes, date of next appointment: _____________________________________________

List all treatment dates:______________________________________________________________________________________________________

Please describe treatment plan: _______________________________________________________________________________________________

If patient is no longer under your care, please provide name and phone number of current physician:

Unknown ❏

 

 

 

Has patient been confined to a hospital? Yes ❏ No

❏ Admitted: ___________________________

Discharged: _____________________________

Hospital Name:

Phone Number:

 

 

 

 

If surgery is/was necessary, please list procedure(s):

 

 

 

 

 

Date scheduled:

Date performed:

 

Prognosis: Please list date(s) of temporary total disability (unable to work) From: ________________ Through: __________________

If patient is currently totally disabled, please indicate the anticipated length of disability by checking the appropriate box below:

Months: ❏

❏

❏

❏

❏

❏

❏

❏

❏

❏

❏

❏ or Permanently Disabled ❏ or Other

❏ ________________________

1

2

3

4

5

6

7

8

9

10

11

12

 

 

Impairment: List functional limitations/restrictions that render your patient temporarily totally disabled:

 

 

 

 

 

 

 

 

 

 

Attending Physician’s Name: (please print)

 

 

 

 

Degree:

 

Specialty:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Street Address:

 

 

 

 

 

 

 

 

 

 

City:

 

State/Zip Code:

 

 

 

 

 

 

 

 

 

 

 

 

Office Phone Number:

 

 

 

 

 

 

 

 

Fax Phone Number:

 

Federal Tax ID Number:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Form completed by:

Title:

Signature of Physician:

Date:

 

 

Attention Physician: This form documents your verification that the above named individual is totally disabled from their occupation. You will be asked periodically for updates related to the individual’s disability and treatment plan.

BD-1321-0706

Get Boston Mutual Claim Bd 1321 0706 PDF Form

Form Characteristics

Fact Name Description
Form Purpose The Boston Mutual Claim Bd 1321 0706 form is used to file a claim for group disability benefits.
Three Required Sections Claimants must complete the Employee, Physician, and Employer sections to ensure thorough processing.
Submission Method Completed forms can be mailed or faxed to Boston Mutual Life Insurance Company for processing.
Important Contact Claimants can contact Boston Mutual at 1-800-320-4445 for questions about the claim process.
Governing Law This claim form is governed by the laws of the state in which the policy was issued, often including ERISA regulations.

Guidelines on Utilizing Boston Mutual Claim Bd 1321 0706

Completing the Boston Mutual Claim Bd 1321 0706 form involves several steps to ensure all necessary information is accurately provided. After filling out the form, it is essential to submit it along with supporting documentation to avoid delays in processing claims.

  1. Fill out the "Employee - Initial Disability Benefits Claim Form" completely. Provide your name, Social Security Number, date of birth, and contact details.
  2. Indicate if you have dependents under age 18, and if so, list their names and birth dates.
  3. Describe the medical condition or injury causing your disability. If it was caused by an accident, explain the details of the incident.
  4. Specify if the disability is related to your employment. If yes, include a copy of any Workers' Compensation award or denial letter.
  5. List all medical treatment dates relevant to your current disability.
  6. State if you have a history of the same or similar condition and provide explanations if applicable.
  7. Provide the names and phone numbers of your treating physician(s).
  8. Note the date you last worked and your anticipated return date, if applicable.
  9. Decide if you want federal taxes withheld from your benefits and specify the amount.
  10. Identify any other income sources you are receiving or may receive during your disability.
  11. Have your treating physician complete the "Physician - Initial Disability Claim Form".
  12. Request that your employer complete the "Employer - Initial Claim Form".
  13. Once all forms are completed, submit them either by mail or fax. Use the address or fax number provided.

After submission, keep a copy of all forms for your records. Following this, you may contact the provided support number for any inquiries regarding your claim status.

What You Should Know About This Form

What is the purpose of the Boston Mutual Claim Bd 1321 0706 form?

This form is used to file a group disability claim with Boston Mutual Life Insurance Company. It allows employees to apply for benefits after a disability begins. Completing the form accurately and completely is essential for avoiding delays in processing the claim.

How should I complete the form?

The form consists of three parts: the Employee - Initial Disability Claim Form, the Physician - Initial Disability Claim Form, and the Employer - Initial Claim Form. Each section must be filled out completely. Employees need to provide their information and details regarding their disability. The treating physician must validate the medical condition, while the employer completes the necessary employment-related information.

Where do I submit the completed form?

You can submit all completed forms by mail or fax. If you choose to mail, send them to Boston Mutual Life Insurance Company, Benefits Administration, P.O. Box 268956, Oklahoma City, OK 73126-8956. Alternatively, fax all completed forms to the toll-free number at 1-888-594-5729.

What information is needed about the employee?

The form requires several details including the employee’s name, occupation, Social Security Number, hire date, and status of employment (full-time or part-time). It is important to list the days and hours worked per week, along with any changes in the employee's employment status, such as layoff or termination.

Do I need to include information about other income sources?

Yes, you must list any other income sources that you are currently receiving or might receive during your disability. This includes Social Security Disability, Sick Leave, or any other type of salary continuation. Providing this information helps in assessing the claim appropriately.

Are there any consequences for providing false information?

Yes, filing a claim with intentionally false or misleading information can result in serious consequences, including being charged with insurance fraud. This could lead to both criminal and civil penalties. It is crucial to ensure that all information provided is accurate and complete.

How will I know the status of my claim?

You can inquire about the status of your claim by calling the toll-free number at 1-800-320-4445. The representatives can provide updates and assist with any questions about your claim process.

What happens if the form is not signed and dated?

Failure to sign and date the form may delay the processing of benefits. It is important to complete all sections of the form, ensuring that both the claimant and the physician sign where indicated to expedite the claim review process.

Common mistakes

When filling out the Boston Mutual Claim BD 1321 0706 form, many people inadvertently make mistakes that can lead to delays in processing their claims. Here are nine common mistakes to avoid.

First, it is crucial to complete the entire "Employee - Initial Disability Benefits Claim Form." Often, individuals skip sections they believe are unnecessary or fail to provide adequate details. Doing so can slow down the review process. Each section is designed to gather important information, and missing data can result in immediate delays.

Next, some people submit the form without getting a thorough response from their treating physician. It is vital to ensure that the "Physician - Initial Disability Claim Form" is filled out completely and returned to the claimant. Without this critical piece of the puzzle, the claim remains incomplete, which can stall the entire process.

Employers play a significant role in the claims process, yet many claimants neglect to obtain a fully completed "Employer - Initial Claim Form." Just as importantly, failing to ensure this form is included with the submission can lead to significant delays. This form provides context concerning the employment status and other key information necessary for the claim.

Another prevalent mistake is inadequate attention to detail when specifying the employee's status of employment. Claimants may mislabel their status as "Full Time" or "Part Time.” This misclassification can lead to complications or even denial of the claim.

Inaccurate salary information on the claim can also be a problem. Providing misleading salary figures, whether intentionally or accidentally, could delay processing. Claimants should carefully check to ensure that the amounts listed are precise and correlate with pay stubs or tax documents.

Another error involves skipping the question regarding whether the disability stems from a work-related incident. Missing this important detail may lead to complications, particularly if there is an active Workers’ Compensation claim. A direct connection could change the claim's path and potential benefits significantly.

Before submission, not fully reviewing the claim can create unnecessary headaches. Even after gathering all appropriate forms, overlooking a simple detail, such as an incomplete signature, can cause a delay. Make sure to double-check all parts of the form and the accompanying documentation.

Lastly, some individuals fail to provide clear contact information for their treating physician. Accurate phone numbers and addresses are necessary for the claims processor to reach out easily for additional information. This oversight can significantly slow down the claims review process.

By being aware of these common pitfalls and ensuring all information is filled out comprehensively, claimants can help facilitate a smoother and faster claims process with Boston Mutual.

Documents used along the form

When submitting a claim with the Boston Mutual Claim Bd 1321 0706 form, several other forms and documents may be required to ensure a smooth claims process. Having these documents prepared can help avoid delays in receiving benefits. Here’s a brief overview of forms that might commonly accompany your claim.

  • Employee - Initial Disability Benefits Claim Form: This form must be filled out by the employee seeking benefits. It collects essential personal information, medical details, and income sources during the disability period.
  • Physician - Initial Disability Claim Form: A vital document for the claims process, this form must be completed by the treating physician. It verifies the medical diagnosis and provides necessary treatment details related to the disability.
  • Employer - Initial Claim Form: Your employer needs to fill out this form as it provides important details on your employment status, including hours worked, salary, and any changes in your employment status.
  • Proof of Income: Submission of pay stubs or W-2 forms may be necessary to validate your income before the disability began, helping to determine your benefit amount.
  • Workers' Compensation Documentation: If your disability is work-related, you'll need to provide any Workers' Compensation claim forms or correspondence, including award or denial letters.
  • Authorization to Use or Disclose Protected Health Information: This signed document allows the insurance company to access your medical records and verify the information provided in your claims.
  • Medical Treatment Records: Copies of relevant medical records from your healthcare providers may be required to substantiate your claim and treatment for the disability.
  • Proof of Other Benefits: Documentation regarding any other sources of income or benefits you are receiving, such as Social Security or disability benefits, is often necessary.
  • Personal Identification Documents: A copy of your government-issued ID may be requested to verify your identity and ensure the claim is processed correctly.
  • Complete Claim Statement: To supplement your claim, you may be asked for a personal statement detailing the nature of your disability and how it impacts your ability to work.

Gathering and submitting these documents alongside your Boston Mutual Claim Bd 1321 0706 form can greatly enhance the chances of a swift and efficient claims process. Each piece of information plays a crucial role in ensuring that your situation is understood and assessed correctly for benefit eligibility.

Similar forms

  • Employee Initial Disability Claim Form: This document collects personal information from the employee about their disability. Like the Boston Mutual Claim Bd 1321 0706 form, it requires detailed medical information regarding the disability.
  • Physician Initial Disability Claim Form: Physicians must complete this form to provide medical evidence supporting the disability claim. It aligns with the Boston Mutual Claim in needing a medical professional's input to validate the claim.
  • Employer Initial Claim Form: This document gathers information from the employer about the employee’s job status. Similar to the Boston Mutual Claim form, it documents the employee’s employment details and contributions, which are essential for processing claims.
  • Workers' Compensation Claim Form: This form is submitted when an employee's disability is work-related. It is similar because it also requires accurate reporting of the disability and may involve the same supporting medical documentation.
  • Social Security Disability Application: This application collects extensive information about an individual’s disability. It shares a focus on medical history and treatment, much like the Boston Mutual Claim form.
  • Long-Term Disability Claim Form: Similar to the Boston Mutual form, this document is used to claim benefits for extended disabilities, focusing on proof of medical condition and employment status.
  • Health Insurance Portability and Accountability Act (HIPAA) Authorization Form: This form allows the sharing of medical information needed for disability claims, just as the Boston Mutual form requires authorization to access medical records.
  • Life Insurance Claim Form: When seeking benefits from a life insurance policy, this document requires personal and medical information. It parallels the Boston Mutual Claim form in the need for thorough documentation to process the claim effectively.

Dos and Don'ts

When filling out the Boston Mutual Claim Bd 1321 0706 form, it's essential to take care to ensure timely processing and accuracy. Here is a list of dos and don’ts to guide you through the process:

  • Do complete the "Employee - Initial Disability Benefits Claim Form" fully and clearly.
  • Do have your treating physician fill out the "Physician - Initial Disability Claim Form" accurately and return it to you.
  • Do ensure your employer completes the "Employer - Initial Claim Form" and returns it to you promptly.
  • Do submit all completed forms using the provided mailing address or fax number without delay.
  • Don't leave any sections of the claim form blank, as this could lead to processing delays.
  • Don't submit forms before your disability begins to avoid complications with your claim.
  • Don't forget to keep a copy of all forms for your personal records.
  • Don't neglect to sign and date all required sections of the forms, or it will lead to further delays in benefits.

Misconceptions

Many individuals navigating the process of filing a claim with the Boston Mutual Claim Bd 1321 0706 form may hold certain misconceptions. Understanding the facts can help ensure a smoother experience. Below are ten common misconceptions, clarified for better comprehension.

  1. All parts of the form can be completed before a disability begins. In fact, it's essential to fill out this form only after the disability has started to avoid delays in processing.
  2. The employer needs to be involved only if the claim is denied. This is not true. The employer must complete their section regardless of the status of the claim.
  3. Submitting the form via email is an option. Actually, claims must be mailed or faxed using the provided toll-free numbers; email submissions are not accepted.
  4. Receiving any benefits means you can’t work at all. The forms require details about your work status, and benefits can still be received if you're working part-time or receiving certain types of income.
  5. You can leave out any income sources not directly related to your disability. It's important to disclose all sources of income, as this can impact the processing of your claim.
  6. A lack of documentation will not affect my claim. In reality, failing to provide necessary documents can lead to delays or denials of benefits.
  7. One physician's approval is sufficient. The process requires documentation from both the employee and their treating physician. Both perspectives are essential for a thorough evaluation.
  8. The authorization to disclose information is optional. While you can refuse, doing so may result in the denial of your benefits, since the insurance company needs access to necessary medical records.
  9. Taxes on benefits can be ignored. Federal taxes can be withheld from benefit payments upon request, and failing to indicate preferences might lead to unexpected tax liability later.
  10. Not signing the form will not impact my claim. It’s crucial to sign and date the form. Failure to do so can significantly delay the processing of benefits.

Correcting these misconceptions can help ensure all necessary steps are followed and increase the likelihood of a successful claim experience.

Key takeaways

Here are key takeaways for completing and using the Boston Mutual Claim Bd 1321 0706 form:

  • All sections of the claim forms must be filled out after the disability begins to ensure timely processing.
  • Contact Boston Mutual's toll-free number at 1-800-320-4445 for assistance during the form-filling process.
  • Complete the "Employee - Initial Disability Benefits Claim Form" thoroughly.
  • Your treating physician must fill out the "Physician - Initial Disability Claim Form" and return it to you.
  • Employers must complete the "Employer - Initial Claim Form" before you submit everything.
  • Submit all completed forms to Boston Mutual via mail or fax. The toll-free fax number is 1-888-594-5729.
  • Ensure that you include all necessary information about the disability, including prior medical history, to avoid delays.
  • Failure to sign and date the forms may result in delays in benefits.
  • Review the form carefully to understand and comply with any requirements regarding the disclosure of protected health information.

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