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Aetna STD Disability Form

Aetna STD Disability Form 2026

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4.3 out of 5

49 votes

The document is a form for employees to request Short-Term Disability (STD) benefits from Aetna when their disability absence exceeds the waiting period. It includes sections for employer and employee information, claim details, physician's statement, and legal disclaimers regarding fraud. The form requires completion by both the employee and their attending physician to assess the nature of the disability and expected return to work date.

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Click ‘Get Form’ to open it in the editor.
Begin with the Employer Information section. Fill in your employer's name, control number, and address including ZIP code.
Next, move to the Employee Information section. Enter your Social Security Number, name, birthdate, and address. Indicate if your employment has terminated or if you are currently on layoff.
In the Claim Information section, specify whether your absence is work-related and provide details about any accidents. Describe the nature of your illness or injury and state your expected return to work date.
Complete the Release section by signing and dating it. Ensure that all information is accurate as it will be used for claim evaluation.
Finally, review all sections for completeness before submitting the form back to your employer via mail or fax.

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See more Aetna STD Disability Form versions

We've got more versions of the Aetna STD Disability Form form. Select the right Aetna STD Disability Form version from the list and start editing it straight away!

Versions	Form popularity	Fillable & printable
2018	4.7 Satisfied (45 Votes)
2018	4.3 Satisfied (49 Votes)
2014	4.5 Satisfied (48 Votes)
2008	4 Satisfied (54 Votes)

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