Get 8668250186

Filling out the 8668250186 online can seem daunting, but this guide will provide clear and supportive instructions to help you successfully complete the process. By carefully following each step, you will ensure that your short-term disability claim is submitted correctly.

Follow the steps to fill out the form accurately and efficiently.

1. Click ‘Get Form’ button to access the form and open it for editing.
2. Begin by filling out Section 1, which contains your participant information. Include your participant’s identification number, date of birth, full name, complete address, employer name, and date of the accident if applicable.
3. For accident-related claims, indicate where the accident occurred by selecting the appropriate option (home, work, auto, or other) and provide an explanation of how the accident occurred, if necessary.
4. Complete the authorization section, which allows your doctor or relevant parties to disclose information about your condition. Ensure you sign this section.
5. Move to Section 2, which requires the physician’s statement. Your doctor needs to fill in their name, date, diagnosis, treatment plan, and the actual or estimated return to work date. They must also indicate if the condition is related to your employment.
6. Section 3 should be completed by your employer or HR representative. This section includes details on your last day worked, actual return date, and whether a workers' compensation claim has been filed.
7. Once all sections are complete with accurate information, review the form thoroughly for any errors or missing information.
8. After verifying that the form is filled out correctly, you can save the changes, download the document, print it for submission, or share it as needed.

Complete your documents online today to ensure an efficient submission process.