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Colonial short term disability form

Continuing disability claim form 2026

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4.8 out of 5

60 votes

The document is a claim form for Continuing Disability benefits from Colonial Life & Accident Insurance Company. It outlines the process for submitting a claim, including sections to be completed by the claimant, employer, and physician. The form requires personal information, details about the disability, and certifications regarding fraud. It also provides instructions for submitting additional information online and options for service agreements.

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Click ‘Get Form’ to open the continuing disability claim form in the editor.
Begin with Section 1, the Claimant Statement. Fill in your name, date of birth, and Social Security Number. Indicate your relationship to the policy owner and specify whether the claim is for an accident or sickness.
Provide details about your inability to work, including dates and conditions that prevent you from performing daily activities. Ensure all responses are legible.
In Section 2, the Employer Statement, have your employer complete their portion regarding your employment status and any relevant details about your job duties.
Finally, Section 3 requires a physician's statement. Ensure your doctor fills this out accurately, detailing your diagnosis and treatment plan.

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Versions	Form popularity	Fillable & printable
2020	4.8 Satisfied (60 Votes)
2019	4.3 Satisfied (162 Votes)
2018	4.3 Satisfied (37 Votes)
2012	4.2 Satisfied (52 Votes)

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