Get Short-tem Disability Claim Form - Houze Employee Benefits - Houze

Completing the Short-term Disability Claim Form is a crucial step in securing your benefits effectively. This guide will provide you with clear, step-by-step instructions to ensure that you fill out the form correctly and submit it seamlessly.

Follow the steps to successfully complete and submit your claim.

1. Click ‘Get Form’ button to obtain the form and open it for editing.
2. Enter your full name in the designated fields, including your last, first, and middle initial.
3. Provide your Social Security Number accurately to facilitate processing.
4. Complete your street address, city, state, and zip code to ensure proper correspondence.
5. Fill in your phone number along with the area code for any follow-up communication.
6. Include your email address and indicate whether you consent to be contacted via email.
7. Record the date you last worked and the date your disability began.
8. Indicate your gender and provide information regarding any previous similar conditions.
9. Describe your current sickness or the circumstances surrounding your injury in detail.
10. Complete the section regarding your height, weight, and hospitalization status if applicable.
11. Specify the nature of your disability and whether it is linked to your occupation.
12. Answer questions regarding previous claims or benefits you may have applied for.
13. Fill out the fields related to income from other sources related to your disability.
14. Sign and date the form to affirm that the information provided is accurate and complete.
15. Choose your payment method and provide the required banking details if selecting direct deposit.
16. Check to ensure all sections are complete, and verify accuracy before submission.
17. Save changes to the form, download, print, or share as needed to finalize your submission.

Completing your Short-term Disability Claim Form online is quick and efficient. Start the process now to ensure timely benefits.