Get Long Term Form

Filling out the Long Term Form online can seem daunting, but with the right guidance, it can be a straightforward process. This guide will walk you through each step, ensuring that you complete the form accurately and efficiently.

Follow the steps to complete the Long Term Form successfully

1. Click the ‘Get Form’ button to access and open the form.
2. Begin by entering your personal information in Section 1. This includes your name, address, phone number, and employer details. Be sure to fill in all required fields marked as ‘MUST ANSWER’.
3. In Section 2, provide your claim information, answering whether the injury or condition occurred at work. Input dates related to your treatment and any dependent information if applicable.
4. Continue filling out the form by answering questions related to your disability and previous treatments. Include full details about your primary attending physician and any other physicians who have treated you in the past two years.
5. Complete all applicable sections regarding your medical history, current condition, and limitations in performing job duties. This helps in establishing a claim for your disability.
6. After all sections are filled out, carefully review the information for accuracy. Once verified, sign the form. If you are an authorized representative, attach the legal documents that authorize you to act on the claimant's behalf.
7. Submit the completed form by faxing it to expedite processing. Ensure to keep a copy of the original for your records.
8. Finally, you can save the changes, download, print, or share the form as needed.

Complete your Long Term Disability Claim Form online today for a smoother process.