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ReferenceReferenceShort Term Disability Claim Form - AnthemShort Term Disability Claim Form - Anthem

ReferenceReferenceShort Term Disability Claim Form - AnthemShort Term Disability Claim Form - Anthem 2025

ReferenceReferenceShort Term Disability Claim Form - AnthemShort Term Disability Claim Form - Anthem Preview on Page 1

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The document is a Short Term Disability Claim Form from Anthem Life Insurance Company, outlining the process for employees to file a claim for short-term disability benefits. It includes sections for the employee, employer, and attending physician to complete, along with necessary authorizations for information release. The form emphasizes the importance of accurate information to avoid fraud and provides contact details for submission.

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Click ‘Get Form’ to open the Reference Short Term Disability Claim Form - Anthem in the editor.
Begin with Section 1, where you will enter your personal information including your last name, first name, Social Security number, and contact details. Ensure all fields are filled accurately.
Indicate your marital status and gender, then provide details about your disability, including the date you last worked and expected return date.
In Section 2, have your employer complete their part by providing group policy number, employment dates, and job title. They should also confirm if the disability arose from work-related incidents.
Section 3 requires your physician to fill out their observations regarding your condition. Make sure they complete all necessary fields for a comprehensive assessment.
Finally, review all sections for accuracy before signing the Authorization for Release of Information and submitting the form as instructed.

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What is the difference between Blue Cross, Blue Shield, and Anthem?

Anthem is part of the Blue Cross Blue Shield group. Blue Cross Blue Shield is made up of independent companies. Anthem is one of these companies. Other Blue Cross Blue Shield brands include Highmark, Regence and CareFirst.

What not to say to long-term disability?

However, any suggestion that you can work despite your disability will adversely affect your claim. Overplaying the severity of your disability Do not exaggerate when describing your disability. Use simple, factual descriptions of your limitations.