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  • Continuing Disability Claim Form - Summit Insurance Services

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DUCK CONTINUING DISABILITY CLAIM FORM Thank you for trusting Aflac with your Continuing Disability needs. If you are interested in uploading documentation on an existing claim, register using aflac.com/smartclaim.

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How to Certify. For Disability Insurance claims, fill out and sign Part B – Physician/Practitioner's Certificate on the Claim for Disability Insurance (DI) Benefits (DE 2501) form. Mail it in within 49 days from the date your patient's disability begins.

Claim for Disability Insurance (DI) Benefits (DE 2501) – English: You must submit an original form provided by the EDD, either electronically or through US mail. It cannot be downloaded or reproduced. To submit the DE 2501 electronically, visit How to File a Disability Insurance Claim in SDI Online.

You may submit medical certifications using SDI Online or by completing and mailing the paper claim form: Claim for Disability Insurance (DI) Benefits (DE 2501) or Claim for Paid Family Leave (PFL) Benefits (DE 2501F). For more information, visit Certify and Manage Claims – Basics for Physicians/Practitioners.

Complete the entire form by answering all questions using black or blue ink. Provide your gross wages, total number of hours worked, and complete employer information for each week that you worked. Be sure to sign your name next to the “X” on the signature line and return the form by the due date indicated.

If you have an SDI Online account, you can submit the DE 2593 online. When the form is available to complete, you will receive an email to log in to SDI Online. Select Continued Eligibility Questionnaire in your inbox. You must complete and submit the DE 2593.

Downloading and Printing The forms are in Portable Document Format (PDF). You may need to download the no-cost Adobe Reader to view and print linked documents.

The DE 2500A, commonly called a continued claim certification, is your request for continued disability benefits. By signing and dating the front of the form, you certify that during the dates shown on the continued claim certification you were still disabled.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232