Get Std Claim Form (connecticut) - United Group Programs, Inc.

Filling out the STD Claim Form is a crucial step in initiating your short-term disability benefits. This guide provides clear and comprehensive instructions to help you efficiently complete the form online, ensuring you capture all necessary details accurately.

Follow the steps to complete your STD claim form with ease.

1. Press the ‘Get Form’ button to retrieve the STD Claim Form (Connecticut) from United Group Programs, Inc. Open the document in your preferred digital format, ensuring it is ready for completion.
2. Begin by filling in your full name as it appears on your official documents, followed by your social security number. This information is crucial for identification purposes.
3. Provide your street address, city, state, and zip code. Make sure that the mailing address is current and matches your official records.
4. Enter your phone number, including the area code. This is important for any follow-up communication.
5. Input your email address and specify whether you would like to be contacted via email by checking 'Yes' or 'No'.
6. Record the date you last worked and the date your disability began, along with your date of birth and gender.
7. Indicate whether you have ever experienced the same or a similar condition by selecting 'Yes' or 'No'. If 'Yes', provide the relevant dates.
8. Address whether you were hospitalized due to your condition by selecting 'Yes' or 'No' and document the dates of confinement if applicable.
9. Select the type of your disability, whether it is due to sickness, injury, or an other condition. Provide a description of your situation in the designated area.
10. Complete the sections asking about your work status: indicate the date you returned to part-time or full-time work, if applicable.
11. Specify whether your disability is occupation-related and if you have filed, or intend to file, a Workers' Compensation claim.
12. List the healthcare professionals who have treated you for this disability and ensure you attach any additional information required.
13. Select whether you would like Federal Income Taxes withheld from your benefits and indicate the amount that should be withheld each week if applicable.
14. Describe any other income you are receiving, or that you have applied for, including Social Security, Workers' Compensation, or any other relevant sources.
15. Review the statement of truth, provide your digital or handwritten signature, and date your submission. This confirms that all information is complete and accurate.
16. Choose your payment method for the benefits and provide the necessary banking details if you select direct deposit.
17. Once all sections of the form are completed, you can save your changes, download a copy, print, or share the form according to your needs.

Complete the STD Claim Form online now to initiate your claim process.