Unum Short Term Disability Claim Form - ccrta 2026

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The document is a Disability Claim Form provided by Unum Group for individuals seeking disability benefits. It outlines the process for submitting a claim, including sections for personal information, medical conditions, employer statements, and physician assessments. The form emphasizes the importance of accurate information to evaluate eligibility and includes fraud warnings specific to various states. It also provides contact information for assistance during the claim process.

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Click ‘Get Form’ to open the Unum Short Term Disability Claim Form - ccrta in our platform.
Begin by filling out the Employee/Individual Statement on pages 3-5. Provide your personal information, including your name, date of birth, and social security number. Ensure all fields are completed legibly.
In section B, detail the condition(s) causing your disability. Answer questions regarding pregnancy, illness, or injury as applicable.
Complete section C with information about your disability, including the date you last worked and any medical treatment providers you have seen.
Proceed to section E to disclose any other sources of disability income that may affect your claim.
Finally, sign and date the Employee/Individual Authorization on the last page to allow for necessary information sharing.

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