United of omaha 2026

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Click ‘Get Form’ to open the United of Omaha Short-Term Disability Claim Form in the editor.
Begin with Part I – Employee Statement. Fill in your Employer Name, Policy Number, Job Title, and personal details such as Name, Address, City, State, ZIP, Social Security Number, Phone Number, Date of Birth, Height, and Weight.
Indicate the Date of Disability and whether it is work-related. Provide details about your physician and nature of illness or accident.
In Part II – Employer’s Statement, your employer will need to complete sections regarding Company Name, Policy Number, Weekly earnings, and confirm if a workers’ compensation claim has been filed.
Finally, in Part III – Attending Physician’s Statement, ensure your physician fills out all required fields including Diagnosis and any functional limitations.

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