Get Disability Income Benefits - Long Term Disability Employer Statement

Filling out the Disability Income Benefits - Long Term Disability Employer Statement online is a crucial step in facilitating a claim for long-term disability benefits. This guide provides clear instructions and support for completing the necessary sections of the form accurately and efficiently.

Follow the steps to complete the employer statement online:

1. Use the ‘Get Form’ button to access the Disability Income Benefits - Long Term Disability Employer Statement online.
2. Begin by entering your company name and plan number at the top of the form.
3. In the employee identification section, carefully fill out all relevant fields, including the first name, middle initial, last name, social insurance number (if the plan is taxable), date of birth, home phone number, and home address.
4. Proceed to the employment information section, providing the employee's job title, effective date of hire, gross earnings prior to the disability, employment status (full-time, part-time, etc.), and regular number of scheduled hours.
5. Review the coverage information, which includes the dates the employee signed for coverage, the amount of basic and optional life insurance, and any excess long-term disability insurance.
6. Fill in the employee tax information, ensuring that you indicate any tax exemptions and provide relevant year-to-date deduction amounts if applicable.
7. Enter absence information, including the last day worked, first day absent, reasons for absence, and any related worker’s compensation claims.
8. Provide declaration information, confirming accuracy of the information entered, and include the date, contact person’s name, job title, email, and authorized signature.
9. Finally, review the entire form for completeness and accuracy before saving, downloading, or sharing the document as needed.

Start completing the Disability Income Benefits - Long Term Disability Employer Statement online to ensure a smooth claim process.