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1257-02 DRAFT indd - mmeht

1257-02 DRAFT indd - mmeht-2025

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The document is a claim form for income protection benefits, specifically for short-term disability (STD) issued by Unum Group subsidiaries. It outlines the necessary steps and information required from the attending physician, employer, and employee to process the claim. The form emphasizes the importance of timely submission within 90 days of disability and includes sections for medical statements, employer verification, and employee details. Additionally, it contains fraud warnings and an authorization section for the release of health information.

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2015	4.8 Satisfied (195 Votes)

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