Get Unum Cl-1104 2021

Completing the UNUM CL-1104 form online is a critical step in managing your short-term disability claim. This guide provides detailed, step-by-step instructions to help you navigate the process with ease and confidence.

Follow the steps to complete your disability claim form effectively.

1. Press the ‘Get Form’ button to access the UNUM CL-1104 form and open it in your chosen editor.
2. Begin with the Employee Statement (pages 4-5). Fill out your personal information, including your last name, first name, date of birth, and social security number, ensuring all details are accurate.
3. In section A, provide your home address, telephone number, and email address. Specify your language preference and type of disability coverage you possess with Unum.
4. Move to section B, where you will provide information about your family and marital status, including your spouse or partner’s name and employment status.
5. Section C focuses on your disability. Clearly indicate whether it is due to pregnancy or another illness/injury. Answer each question thoroughly, including details regarding hospital visits or surgeries related to your medical condition.
6. In section D, list your current medical providers, ensuring to include their contact information and service dates.
7. Complete section E regarding income tax withholding. Specify if you want taxes withheld, including the amounts for Federal and State if applicable.
8. In the last section of the Employee Statement, sign and date the form to confirm that the information is accurate. Ensure you read through the fraud warnings listed.
9. Proceed to the Authorization sections to allow Unum to share your information with third parties if desired. Fill in any necessary details and ensure signatures are obtained.
10. Have your employer fill out the Employer Statement (pages 7-8) if applicable. They will also need to sign and date this section.
11. Finally, provide the Attending Physician Statement (pages 9-10) to your physician for completion, ensuring they send it to Unum with any necessary details concerning your treatment.
12. After filling out all relevant sections, you can save changes, download, print, or share the form as needed.

Start filling out your UNUM CL-1104 form online today to manage your claim efficiently.