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Get Trustmark Disability Claim Form

Ss 1 2 3 4 5 - No limitation of functional capacity; capable of heavy work*. No restrictions. (0-10%) Medium manual activity*. (15 - 30%) Slight limitation of functional capacity; capable of light work*. (35 - 55%) Moderate limitation of functional capacity; capable of clerical/administrative (sedentary*) activity. (60 - 70%) Severe limitation of functional capacity; incapable of minimum (sedentary*) activity. (75 - 100%) Remarks: (b) Mental Impairments (If Applicable) (a) Please define s.

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