AI Short-Term Disability Claims Agent

How Cassidy automates this using AI

Step 1: Trigger on new claim submission

The Workflow activates when a disability claim arrives—whether from an employee self-service portal, HRIS file feed, manager submission, or TPA integration.

Step 2: Validate and enrich claim data

Cassidy pulls employee identifiers, plan details, earnings basis, elimination period, and treating provider information from connected systems—flagging incomplete fields for immediate follow-up.

Step 3: Initiate DOL-aligned FMLA coordination

When FMLA applies, Cassidy automatically opens a parallel case, generates WH-381 eligibility and rights notices, and sends the appropriate certification form (WH-380-E) with tracked deadlines.

Step 4: Chase medical documentation

The Workflow sends APS requests to treating providers, tracks response deadlines, and escalates overdue documentation—reducing the back-and-forth that delays adjudication.

Step 5: Surface claim for determination

Cassidy compiles medical restrictions, job duty analysis, and duration guideline checks into a single case view—presenting everything the leave admin needs to make the disability determination with full context.

Step 6: Generate decision and payment setup

Once approved, Cassidy drafts the decision letter with benefit calculations, offset details, and recertification dates—then routes payment setup to payroll with direct deposit preferences.

Step 7: Coordinate return-to-work

As the approved period ends, the Workflow triggers RTW outreach, schedules fitness-for-duty collection when required, and initiates ADA accommodation handoffs—keeping the employee informed at every step.