Claim Forms
Online Claim Submission
The Short Term Disability claim application is divided into four sections (Employer's Statement, Employee's Statement, Authorization and Attending Physician Statement (APS)), all of which will be required to process the application for claim payment.
As the employee, you are required to complete the Employee's Statement and the Authorization form in their entirety prior to submission.
As the Employer Statement and APS are required to complete the claim application, please notify your employer and physician that you will be filing a claim and request that they each complete their portion of the claim application.
You may email the completed Employee’s Statement and Authorization Form to [email protected]. Please be advised, the claim will not be processed until all four sections noted above are completed and submitted to the claim team.
As the employee, you are required to complete the Employee's Statement and the Authorization form in their entirety prior to submission.
As the Employer Statement and APS are required to complete the claim application, please notify your employer and physician that you will be filing a claim and request that they each complete their portion of the claim application.
You may email the completed Employee’s Statement and Authorization Form to [email protected]. Please be advised, the claim will not be processed until all four sections noted above are completed and submitted to the claim team.
The Short Term Disability claim application is divided into four sections (Employer's Statement, Employee's Statement, Authorization and Attending Physician Statement), all of which will be required to process the application for claim payment.
As the employer's authorized representative, you should complete the Employer's Statement in its entirety prior to submission.
You may email the completed Employer’s Statement to [email protected]. Please be advised, the claim will not be processed until all four sections noted above are completed and submitted to the claim team.
As the employer's authorized representative, you should complete the Employer's Statement in its entirety prior to submission.
You may email the completed Employer’s Statement to [email protected]. Please be advised, the claim will not be processed until all four sections noted above are completed and submitted to the claim team.
The Short Term Disability claim application is divided into four sections (Employer's Statement, Employee's Statement, Authorization and Attending Physician Statement), all of which will be required to process the application for claim payment.
As the attending physician, you are required to complete the Attending Physician Statement in its entirety prior to submission.
You may email the completed Attending Physician's Statement to [email protected].
As the attending physician, you are required to complete the Attending Physician Statement in its entirety prior to submission.
You may email the completed Attending Physician's Statement to [email protected].
Disability Claim Status
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