Tdi 45 2026

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The document provides detailed instructions for filing a claim for disability benefits with Hartford Life and Accident Insurance Company. It outlines the necessary steps, including obtaining a claim form, completing various statements by the claimant, employer, and physician, and submitting them within specified timeframes. The document also emphasizes the importance of non-discrimination in the claims process and offers contact information for assistance.

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Click ‘Get Form’ to open the TDI-45 in the editor.
Begin with Part A, Claimant’s Statement. Fill in your name, Social Security Number, and contact details. Ensure you select your sex and marital status.
Provide detailed information about your disability, including its cause and the first day you were unable to work. Indicate if it was job-related.
Complete employment information by entering your current employer's details, occupation, and earnings prior to the disability.
In Part B, ensure your employer fills out their section accurately. This includes wage information and confirmation of employment status.
Finally, have your physician complete Part C with their assessment and signature before submitting the form.

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