Get Group Short-term Disability Statement Of Employee - Filco

This guide provides a step-by-step approach to accurately complete the Group Short-Term Disability Statement of Employee - FILCO form online. It aims to assist users in navigating the various sections of the form with clarity and confidence.

Follow the steps to successfully complete the form online.

1. Click the ‘Get Form’ button to access the document and open it in your preferred online editor.
2. Enter your full name, including last name, first name, and middle initial in section 1.
3. Provide your Social Security Number in section 2.
4. Fill in your street address, mailing address, city, state, and zip code in sections 4, 5, 6, and 7.
5. Include your email address in section 8 and indicate if you consent to be contacted via email.
6. Record the date you last worked and your date of birth in sections 10 and 9, respectively.
7. Select your gender in section 11 and provide the date of disability.
8. In section 13, indicate whether you have had the same or similar condition in the past and provide dates if applicable.
9. Describe your sickness or injury in section 14a, ensuring to provide detailed information.
10. Fill in your phone number in section 3 and indicate if you were hospitalized in section 12.
11. Specify whether your disability is due to a sickness, injury, or other in section 14 and provide the date of injury if relevant.
12. Complete sections 15 and 16 regarding your return to work status and if your disability is related to your occupation.
13. List the medical professionals who treated you for this disability in section 17, along with their contact information.
14. Decide whether to withhold federal income taxes from your benefits in section 18.
15. Detail any other income you receive or will apply for in section 19; make sure to complete the necessary fields.
16. Review your statements and sign in section 20 to attest that the information provided is accurate.
17. For payment methods, complete section 21 with your financial institution’s name and account details.
18. Once you have filled out all sections, ensure that all information is accurate, and save the document or print the completed form.
19. Finally, you can share the form as needed or submit it in accordance with the guidelines provided on the document.

Start completing your Group Short-Term Disability Statement of Employee - FILCO online today.