Get Initial Disability Claim Form - Calvin, Giordano & Associates

Filling out the Initial Disability Claim Form is a crucial step in accessing your disability benefits. This guide provides a clear and comprehensive approach to help you complete the form accurately and efficiently.

Follow the steps to successfully complete your Initial Disability Claim Form.

1. Press the 'Get Form' button to obtain the Initial Disability Claim Form and open it in an editor.
2. Begin by completing Section A, which includes the Policyholder/Patient Information. Provide your first name, last name, mailing address, city, state, ZIP code, and check the box if this is a new permanent address.
3. Specify the type of disability you are filing a claim for by checking all applicable boxes, such as Disability due to Accident, Sickness, Cancer, or Pregnancy/Complications. Ensure you include your policy number(s) on all documents.
4. Your employer must complete Section B: Employer's Statement. This includes details such as the date of hire, first date of disability, and whether the person is still employed.
5. In Section C: Physician's Statement, your healthcare provider is required to complete and provide their name, contact information, diagnosis, and treatment related to your condition.
6. Verify that all sections of the form are filled out accurately, and ensure they are signed by the respective parties — yourself (the claimant), your employer, and your physician.
7. Once all sections are complete and signed, you can save your changes, download the form, print it, or share it as necessary.

Complete your Initial Disability Claim Form online today to ensure prompt processing of your benefits.