Get Application For Group Short Term Disability Benefits Employers Statement

Filling out the Application For Group Short Term Disability Benefits Employers Statement online is an important step in the claims process. This guide aims to provide clear and supportive instructions on how to accurately complete each component, ensuring a smooth submission.

Follow the steps to complete the application effectively.

1. Click ‘Get Form’ button to obtain the form and open it in the designated editor.
2. Begin with section A, Employer Identification. Enter the employer's name, group policy number, division number, and contact address. This information is essential to identify the employer and associated benefits.
3. Progress to section B, Employee Identification. Fill in the employee's name and identification numbers. This ensures the claim is correctly matched to the employee's records.
4. In section C, Employment Information, provide details such as the effective date of hire, employment class, and last day worked. Be specific about the reason for absence, selecting from the provided choices to assist in accurately categorizing the claim.
5. Continue to section D, Insurance Information. Fill in the original effective date of the employee’s short-term disability coverage and indicate whether the employee was a late applicant.
6. Move to section E, Earnings and Benefit Information, where you will detail the employee's pre-disability earnings and average weekly commissions. Accurate information is critical for benefits determination.
7. Complete the Job Information section F by documenting the employee’s job title, duration in position, and details regarding job duties and performance changes due to disability. This helps assess the claim properly.
8. If necessary, provide any Additional Information that might be relevant for the claim assessment.
9. Finally, review the Declaration statements, ensuring accuracy in all provided information. Then, provide the authorized signature, date, printed name, title, and contact information to finalize the form.
10. Once the form is complete, save your changes, download a copy for your records, and ensure it is submitted promptly, ideally within the required five days.

Begin completing your Application For Group Short Term Disability Benefits Employers Statement online today.