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Colonial life disability claim form

Colonial life work disability form 2026

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The document is a claim form for Colonial Life's accident insurance, detailing the process for filing an accident claim. It includes instructions for submitting claims via fax or online, optional service agreements, and sections for claimant, employer, and physician statements. The form emphasizes the importance of accurate information to avoid fraud and outlines the necessary documentation required for processing claims.

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Click ‘Get Form’ to open the colonial life work disability form in the editor.
Begin with Section 1, the Claimant Statement. Fill in your name, date of birth, and Social Security number. Indicate your relationship to the policy owner and ensure all information is legible.
Proceed to Section 2, Accidental Injury. Provide details about the accident, including the date it occurred and whether it was on or off the job. Attach any relevant medical bills and descriptions of how the accident happened.
In Section 3, if applicable, have your employer complete their portion regarding on-job injuries. Ensure they provide a description of the accident and their signature.
Complete Section 4 by having your physician fill out their statement. Include diagnosis codes and confirm if surgery was performed.
Review all sections for completeness before submitting your claim to avoid delays in processing.

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Versions	Form popularity	Fillable & printable
2019	4.8 Satisfied (73 Votes)
2018	4.1 Satisfied (50 Votes)
2018	4.3 Satisfied (69 Votes)
2012	4.3 Satisfied (43 Votes)

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

How much does Colonial Life short-term disability pay per month?

Highlights of our disability plan options include: $400 per month to 60% of your gross monthly income, not to exceed $6,500) Youre paid regardless of any other insurance you may have. Benefits are paid directly to you unless you specify otherwise.

Does Colonial Life short-term disability cover mental health?

If youre disabled with a covered mental or nervous condition, disability insurance from Colonial Life Accident Insurance Company offers a monthly benefit that can help provide financial support while you focus on recovery.

What does Colonial Life disability cover?

Many illnesses typically meet long-term disability qualifications, entitling policyholders to monthly benefits for a certain period of time. Illnesses that may qualify for LTD benefits include heart conditions, strokes, diabetes, depression, and brain injuries.

Whats the payout for disability?

You may be eligible to receive between $50 to $1,681 each week for up to 52 weeks, depending on wages you earned 5-18 months before your claim start date. Our Disability Benefit Calculator helps estimate your benefit amount. Disability benefits do not provide job protection.

Is there a downside to short-term disability?

Disadvantages of short-term disability insurance Exclusions: Most short-term disability insurance policies have exclusions for certain types of disabilities, such as pre-existing conditions or disabilities caused by certain activities. You may not be covered if you become disabled due to one of these exclusions.

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Is Colonial Life good to work for?

Colonial Life Accident Insurance Co. has an overall rating of 3.7 out of 5, based on over 1,053 reviews left anonymously by employees. This rating has increased by 5% over the last 12 months.

Colonial life work disability form 2026

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