Get Notice And Proof Of Claim For Disability Benefits Part ... - Fordham

This guide provides users with a detailed overview on how to complete the NOTICE AND PROOF OF CLAIM FOR DISABILITY BENEFITS PART ... - Fordham form, ensuring a smooth submission process. Whether you are filling out the form for the first time or need a refresher, this guide offers clear instructions to assist you.

Follow the steps to accurately complete your claim form.

1. Press the ‘Get Form’ button to access the form and open it for editing.
2. Begin with Part A – CLAIMANT'S STATEMENT. Template each answer fully and accurately. Start by providing your Social Security Number, full name, and contact information including your address and phone number.
3. Complete the date of birth and indicate your marital status by checking the appropriate box.
4. Detail the nature of your disability in question 6, including specifics if it pertains to an injury, such as how, when, and where it occurred.
5. In question 7, state the date you became disabled, including any information about continuing work during this period.
6. List the names and details of all employers for the last eight weeks, ensuring to include their business name, address, telephone number, and the dates of employment.
7. Address questions 10 and 11 regarding any other compensation you may be receiving related to your disability, including Workers’ Compensation or unemployment insurance.
8. After thoroughly answering all questions, ensure you date and sign the claim as per instructions in item 12.
9. If applicable, have your representative sign on your behalf and provide their details as necessary.
10. Remember to mail the completed claim, accompanied by Part B filled out by your health care provider, within 30 days of your disability.
11. Make a copy of the entire completed form for your records before submitting it.

Complete your disability claim form online today to ensure timely processing.