Disability form 2025

1. Click ‘Get Form’ to open the Short-Term Disability Claim Form in the editor.
2. Begin with Part I – Employee Statement. Fill in your Employer Name, Policy Number, Job Title, and personal details such as Name, Address, and Social Security Number. Ensure all fields are completed to avoid delays.
3. Provide information regarding your disability. Indicate the Date of Disability and whether it was work-related. Include details about your physician and any other income claims you have filed.
4. Move to Part II – Employer’s Statement. Your employer will need to complete this section, providing their company details and confirming aspects like weekly earnings and whether a workers' compensation claim has been filed.
5. Finally, in Part III – Attending Physician’s Statement, ensure your physician fills out their information accurately, including diagnosis and treatment details. This section is crucial for validating your claim.

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