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Get Routine Pregnancy Claim Filing Instructions
Ting physician complete the Attending Physician s Statement and return to you. Have your Employer complete the Employer s Report of Claim. Submit the completed: A. Employee s Disability Benefits Application B. Employer s Report of Claim C. Attending Physican s Statement to the address below or submit via our toll-free fax 1-800-818-3453. All portions of this form package must be completed to avoid undue delay in processing claimant s request for benefits. If you have any questions.
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