Short-term disability claim form - initial report of disability 2026

1. Click ‘Get Form’ to open the Short-Term Disability Claim Form - Initial Report of Disability in the editor.
2. Begin with Section 1, where you will enter your Participant’s Information. Fill in your Identification Number, Date of Birth, Full Name, Complete Address, Employer, and Date of Accident. If applicable, answer the accident-related questions.
3. Proceed to Section 2 for the Physician’s Statement. Ensure your doctor fills in the Patient’s Name, Date Disability Began, Diagnosis, and all treatment dates. Confirm if hospitalization occurred and provide details about the treatment plan.
4. In Section 3, complete the Employer’s Statement by providing details about your last day worked and any layoff information. Ensure that your employer signs this section.
5. Review all sections for accuracy before submitting. Once completed, save your document and send it to TeamCare via fax or mail as instructed.

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