Disability
Disability Insurance provides essential support for employees facing prolonged periods of non-work-related illness or injury. When individuals are unable to work due to a totally disabling condition, the DI Plan offers a monthly income benefit.
Long Term Disability (LTD)
Long term disability provides income supplementation to employees who are unable to work due to a disability or severe illness. All of the following forms must be submitted when a claim is filed. All claim forms must have the handwritten signature of the person responsible for completing the form.
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Attending Physician Statement for LTD 5/2024
Long Term Disability (LTD) attending physician statement.
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Direct Deposit Authorization and Long Term Disability Checklist 5/2024
Ensure that all payments are made quickly for Long Term Disability claims and ensure all required documents are submitted.
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Plan Member Statement for LTD 5/2024
Long Term Disability (LTD) plan member statement.
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Plan Sponsor Statement for LTD 5/2024
Long Term Disability (LTD) plan sponsor statement.
Short Term Disability (STD)
Short-Term Disability Insurance provides income replacement for individuals who are temporarily unable to work due to illness or injury. All of the following forms must be submitted when a claim is filed. All claim forms must have the handwritten signature of the person responsible for completing the form.
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Attending Physician Statement for STD 5/2024
Short Term Disability (STD) attending physician statement.
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Direct Deposit Authorization and Short Term Disability Checklist 5/2024
Ensure that all payments are made quickly for Short Term Disability claims and ensure all required documents are submitted.
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Plan Member Statement for STD 5/2024
Short Term Disability (STD) plan member statement.
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Plan Sponsor Statement for STD 5/2024
Short Term Disability (STD) plan sponsor statement.
Waiver of Premium (WOP)
The Waiver of Premium benefit allows the premium payor to stop paying for Life Insurance, Accidental Death and Dismemberment and Critical Illness premiums in the event of a disability. Only submit these forms if you are not already submitting a claim for disability benefits.
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Attending Physician Statement for WOP 5/2024
Waiver of Premium (WOP) attending physician statement.
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Plan Member Statement for WOP 5/2024
Waiver of Premium (WOP) plan member statement.
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Plan Sponsor Statement for WOP 5/2024
Waiver of Premium (WOP) plan sponsor statement.
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Waiver of Premium Checklist 5/2024
Ensure all required documents are submitted for a waiver of premium.
Supplementary disability forms
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Disability Supplementary Medical Information Physician Statement 5/2024
Patient authorization and physician statement for supplemental medical information.
