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This form is primarily required for individuals who are members of the 1199SEIU National Benefit Fund and have become sick or disabled while employed, or within four weeks after termination of employment. It is essential for those who need to file a claim for disability benefits due to medical conditions that prevent them from performing their job duties. For instance, a healthcare worker who sustains an injury on the job would use this form to initiate their claim process. Additionally, individuals who experience sudden health issues, such as severe illness or accidents shortly after leaving their job, must also utilize this form to secure necessary benefits.
To successfully file the 1199 disability form, members must adhere to specific requirements including submission deadlines and necessary documentation. Claims must be submitted within thirty days of becoming sick or disabled. The member's statement must be fully completed and signed, and it is imperative that the healthcare provider also fills out Part B of the form. If applicable, employers must complete Part C before submission. Failure to meet these requirements may result in delays or denial of benefits.
Submitting the 1199 disability form involves several steps that ensure proper processing of your claim. First, obtain the fillable PDF template from DocHub or directly from the fund's website. Next, complete all required sections accurately and gather any necessary supporting documents such as medical records. After filling out Parts A and B, ensure your employer completes Part C if needed. Finally, mail your completed claim package to the address specified by the fund or submit it electronically if available.
It is vital for members to keep copies of all submitted forms for their records in case follow-up is needed later on. Additionally, if there are any changes in circumstances such as returning to work or receiving other types of compensation during the period covered by this claim, these should be reported promptly as they may affect eligibility for benefits.
