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Click ‘Get Form’ to open the plan member statement in the editor.
Begin by selecting the benefit type you are applying for, such as Short Term Disability or Long Term Disability. This is crucial for processing your claim.
Fill in your personal information, including your plan contract number and certificate number, which can be found on your benefit card. Ensure all fields are completed accurately.
If applicable, complete the Direct Deposit section to receive benefits directly into your bank account. Attach a void cheque if necessary.
Provide detailed information regarding your injury or illness, including dates and descriptions. Be thorough to avoid delays in processing.
List all healthcare professionals you have consulted regarding your condition. Include their contact details and frequency of visits.
Review all sections for completeness before submitting. Use our platform’s features to save and share the document easily.
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Death Benefits | Office of the New York State Comptroller
Survivors can report the death of a member using our online death report form or they can call 866-805-0990 and press 3 then 1. Well also need a certified
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