Claim Form - Instant Benefits Network 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by selecting the type of claim you are submitting: Short-Term Disability, Voluntary STD, or Specific Disease Benefit. Fill in your Group Number.
3. In the Claimant's Statement section, enter your personal details including Name, Social Security Number, Height, Weight, Birth Date, and Contact Information.
4. Indicate if you are filing under Workers’ Compensation or Social Security Act by checking 'Yes' or 'No'.
5. Provide details about any other income you are receiving and include amounts for each type listed.
6. Fill in the dates related to your accident or illness and provide a description of the nature of your injury or illness.
7. Complete the Agreements and Authorization section by signing and dating where indicated.

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