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Clear Form THE HARTFORD NOTICE AND PROOF OF CLAIM FOR DISABILITY BENEFITS DB-450 (3-97) CLAIMANT: READ THE FOLLOWING INSTRUCTIONS CAREFULLY 1 2026
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- Click ‘Get Form’ to open it in the editor.
- Begin with Part A, the 'Claimant's Statement.' Fill in your name, Social Security number, and address accurately. Ensure all details are correct.
- Provide your contact number and marital status. Indicate your age and describe your disability, including how, when, and where it occurred.
- Complete the employment history section by listing your last employer(s) along with dates of employment and average weekly wages.
- Answer questions regarding any other benefits you may be receiving. If applicable, provide details about previous disability claims.
- Sign and date the form at the end of Part A. If someone else is signing on your behalf, include their information as well.
- Ensure that Part B is completed by your health care provider before submitting the claim to avoid delays.
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