Please call the NJATU Claims line at (888) 284-2394, 8:00 a.m. through 7:00 p.m. Monday through Friday, and one of our Benefit Counselors will be able to assist you by verifying your coverage and providing the correct claim form.
10 to 15 business days (Processing time can be longer if forms are incomplete, medical records are needed, if a decision is being appealed, or if requested information is not submitted to us.)
Most often, missing/incomplete documents. Other causes include when the policy or coverage increases are in contestable period (within 1 year of the claim), if claim forms are submitted too early, wrong address on file for insured, if altered copies of previous claim forms are submitted, and when you are not under the regular care of a physician.
Pregnancy is considered the same as any other covered illness. A lump sum payment is made for pregnancies; 42 days for a vaginal delivery and 56 days for a caesarian delivery (minus your elimination period). Please note if you are out prior to or after your delivery, a medical necessity letter is needed from your physician that gives your disabling diagnosis, medical treatments you are undergoing, any restrictions you are under and your doctor must certify that you are totally disabled during that additional time.
How often we pay benefits depends on the nature of the claim and can change during the claim. We pay in the form of a check that is sent by standard mail to the address we have on file for you. (Note: please ensure you advise us if you move or need your check mailed to an alternate address, to avoid delays. We cannot stop-pay and reissue a check for 15 days after it was mailed.) We send an explanation of benefits with each payment that specifies any information needed and by when.
Benefits for a pre-existing condition will not be paid during the first 12 months the policy is in force. Pre-Existing Condition means a sickness or physical condition for which within 12 months before the coverage effective date:
Symptoms existed that would cause an ordinary prudent person to seek advice or treatment from a Physician; or
You were treated, received medical advice from a Physician or had taken prescribed medicine.