Waiver of premium claim

How do we take a waiver of premium claim when an insured becomes disabled, collect the medical proof and the claim form, and have the premiums waived in the policy system?

Treat the waiver as a disability claim on the policy. Callvu opens the claim from the insured, their agent or a linked disability claim, prefills the policy (the waiver rider's terms, the waiting period, the age limit, the premium mode and the paid-to date), takes the claim form on a secure screen, chases the attending physician statement and records through the physician's link, checks the proof against the rider's definition and the waiting period, routes the decision to the claims examiner in the Decision Desk, writes the waiver with its effective date and the refund of premiums paid during the waiting period to the policy system, and schedules the continuing proof.

In scopeSimpleCallvu moves: chase and verify, decide, write back

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Last updated November 7, 2026.

The problem today

The policy lapsed for non-payment while the waiver claim was waiting for a physician's form.

Today, without Callvu

An insured with a waiver of premium rider becomes disabled and stops paying. The claim form is mailed, the physician's statement is faxed weeks later, and in the meantime the billing system issues the lapse notice and the policy lapses. Reinstating it, refunding the premiums the rider should have waived, and explaining it all to a disabled policyholder is the carrier's problem to clean up.

The rider defines total disability, sets a waiting period (typically six months of continuous disability) after which premiums are waived back to the start of the disability with premiums paid during the waiting period refunded, requires proof by an attending physician, limits the benefit by the insured's age at disability, and requires continuing proof at intervals. Every element is a check on the policy's data and the physician's statement, and the claim should hold the lapse while it runs.

A waiver claim is a promise the policy made for exactly this moment.

How it runs

From the requestto the system of record.

The insured, their agent or a linked disability claim reports a disability on a policy with a waiver of premium rider. Callvu opens the claim on the policy.

Insured: Completes the claim form and the authorization on a secure screen.
Attending physician: Completes the attending physician statement and provides records through a link.
Claims examiner: Decides the waiver in the Decision Desk.
Callvu: Prefills, holds the lapse, chases the proof, checks, routes and writes back.

Prefill and hold
The rider's definition, the waiting period, the age limit, the premium mode, the paid-to date and the grace period are prefilled from the policy system; a pending waiver claim places a lapse hold on the policy so billing does not lapse it while proof is collected.
Chase and verify the proof
The insured completes the claim form, the disability start date and the HIPAA authorization on their phone; the attending physician statement and records are requested from the physician through a link, read on arrival and checked against the rider's definition, the disability start date and the age limit; reminders run to the insured and the office until complete.
Decide
The claims examiner decides in the Decision Desk with the proof and the rider's computation (the waiting period end, the premiums due and the refund), and only the allowed outcomes: approve the waiver from the rider's date, deny with the specific reasons, or request named material.
Write back and schedule
The waiver with its effective date, the refund of premiums paid during the waiting period, the lapse hold release and the continuing proof date are written to the policy system and the billing system, the insured receives the written decision, and the continuing proof opens on its date through the disability review.

Where it ends: The policy stayed in force while the proof was collected, the waiver was decided on the physician's statement against the rider's terms, and the policy and billing systems reflect the waiver and the refund with continuing proof scheduled. The Decision Trace shows the rider's checks and the decision; the Audit Trace shows the hold, each document and the writes.

Runtime enforcement

What is enforcedwhile the work runs.

The regulations preloaded in Callvu Studio and the bank's own policies, applied as steps that run, not lines in a binder. A step that breaks a rule does not run, so a completed run was compliant.

Regulations

The waiver of premium rider's terms (NAIC model policy provisions and the carrier's filed rider): The rider waives premiums falling due during total disability that begins before the age limit and continues through the waiting period (commonly six months), refunds premiums paid during the waiting period, requires written notice and proof of disability within the rider's period and continuing proof at intervals, and defines total disability by the inability to perform the duties of the insured's occupation or any occupation after a period.
State grace period and reinstatement statutes: A policy may not lapse before the grace period ends; a lapse hold during a pending waiver claim keeps the carrier inside the statute and avoids a reinstatement with evidence of insurability.
HIPAA authorization (45 CFR 164.508) and state disability claim handling rules: Medical records require the insured's authorization, and the state's claim handling rules set the timing of the acknowledgment and the decision.

Company policies

A pending waiver claim holds the lapse; billing never lapses a policy with a waiver claim open.
The physician's statement is chased from the physician, not through the insured.
The decision is the examiner's against the rider's computation, in the Decision Desk.
The policy system and the billing system hold the waiver, the refund and the proof date.

Controls

Rider prefill and lapse hold.
Claim form and authorization on a secure screen.
Physician statement chase with reading and checks.
Rider computation (waiting period, age limit, refund).
Decision Desk decision with required outcomes.
Policy and billing system writes with continuing proof.

Clocks and deadlines

Waiting period: The rider's months of continuous disability before premiums are waived, computed from the disability start date.
Proof of claim: Within the rider's period from the start of disability, with the claim acknowledged on the state's timing.
Continuing proof: At the rider's intervals, opened on the date.

Documents and checks

The claim form and authorization
The attending physician statement and records
The rider computation
The decision and the written notice
The policy and billing system records

In the Decision Trace

The rider's terms and each check.
The decision and the examiner.

In the Audit Trace

The hold with time.
Each document with time.
The writes and the refund.

The handoff

Between the front doorand the back office.

The front door

The insured or their agent in any channel; the physician through their own link.

The back office

The examiner decides on complete proof; billing reads the hold and the waiver.

The Decision Desk

The claim goes to the claims examiner in the Decision Desk with the proof and the rider computation, and only approve from the rider's date, deny with reasons, or request named material.

Proof

In scope.Proof at scale, not one process at a time.

The kind of process Callvu runs in production for customers in this industry. Ask for a reference on this exact process. The results below are the industry's published proof; each claim code links to its record on agents.callvu.com.

Phoenix put more than 100 processes live in under 3 months.

Across Callvu customers

More than 1,000 processes are live across Callvu customers.

Across Callvu customers

Questions

What buyers ask next,answered plainly.

Does the policy lapse while the claim is reviewed?

No. A pending waiver claim places a lapse hold on the policy so billing does not lapse it while the proof is collected.

What proof is required?

The claim form and authorization from the insured and an attending physician statement with records from the physician, checked against the rider's definition, waiting period and age limit.

Are premiums refunded?

Premiums paid during the waiting period are refunded when the waiver is approved, and the waiver runs from the rider's date with continuing proof scheduled.

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