Get Polam Form

Filling out the Polam Form is an essential step in navigating the disability benefits evaluation process under the Hawaii Temporary Disability Insurance Law. This guide provides a comprehensive walkthrough to ensure that you can complete the form accurately and efficiently.

Follow the steps to fill out the Polam Form online effectively.

1. Click the ‘Get Form’ button to obtain the Polam Form. This action will enable you to open the document for editing and preparation.
2. Begin by entering your personal information in the designated fields. This may include your name, contact information, and relevant identification details necessary for the evaluation process.
3. Next, provide specific details regarding your disability. Be clear about the nature of your condition and any relevant medical documentation that supports your claim.
4. Indicate the waiting period you have experienced for both illness and accident. You will need to specify whether the waiting period was between 0 to 7 days.
5. Document the duration of benefits expected. Use the guidelines provided in the form to specify if benefits will last between 2 and 26 weeks.
6. Fill in the percentage of wage loss that is replaced by the disability benefits. This should be a figure between 58% to 100%, depending on your specific plan.
7. After completing all sections, review your entries to ensure accuracy and completeness. This step is crucial to avoid delays in the processing of your form.
8. Finally, save your changes, then download or print the form. You may also choose to share it with your healthcare provider or submit it directly, depending on your situation.

Start completing your Polam Form online today to ensure a smooth evaluation process.