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- Click ‘Get Form’ to open the Group Short-Term Disability Claim Form in the editor.
- Begin by filling out the Claimant Statement section. Enter your name, address, Social Security number, and other personal details accurately.
- In the Nature of Injury or Illness section, provide a detailed description of your condition. Be sure to include dates and any relevant medical history.
- Complete the Employer Statement section if applicable. This includes details about your employment and insurance coverage.
- If you are opting for direct deposit, fill out the Direct Deposit Authorization Agreement with your banking information and attach a voided check.
- Review all sections for completeness. Ensure that all required signatures are present before submitting the form.
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