Get Cigna Long Term Disability Physician Statement Form

Completing the Cigna Long Term Disability Physician Statement Form is an important step in the claims process for disability benefits. This guide will walk you through each section of the form, providing clear and supportive instructions to help you fill it out accurately and efficiently.

Follow the steps to complete the form with ease.

1. Press the ‘Get Form’ button to access and open the form in your document editor.
2. Begin by entering the employee or association member's name, date of birth, social security number, and contact information in the designated fields. Ensure accuracy to prevent delays.
3. Mark the appropriate checkboxes regarding the insured's employment status, occupation, and earnings. This section helps Cigna understand the employment context.
4. Provide details related to insurance contributions and the last day worked. Specify if the employee/member has been laid off or terminated, along with relevant dates and reasons.
5. In the section designated for the claimant, indicate the date of the accident or onset of illness, date first unable to work, and the planned return date. Detail the nature of the illness or injury, including previous similar conditions.
6. List all hospitals, clinics, or physicians involved in the treatment of the individual. Provide specifics on job duties, physical labor percentage, and any other benefits the claimant is receiving.
7. For the attending physician's section, input the diagnosis and any concurrent conditions using specific codes. Ensure to include the dates of service and any surgeries performed.
8. Complete the disclosure authorization part by signing and dating the form, allowing the required access to medical records and information relevant to the claim.
9. After reviewing the entire form for accuracy, save your changes, and then download, print, or share the completed document as needed.

Start filling out your documents online today for an efficient claims process.