LONG TERM DISABILITY CLAIMS
(MONTHLY INCOME BENEFITS)

Remember to complete any applicable Employer form(s) or section(s) before distributing forms to employees.

To submit a claim, you (the employer) need to complete the following forms:
1) Long Term Disability Claim Notice Employer's Statement, and
2) Long Term Disability Occupational Demands

The completed Occupational Demands form (with a copy of the employee's job description attached) needs to be provided to the employee along with the following forms:
1) Long Term Disability Employee's Statement,
2) Attending Physician's Statement of Impairment and Function,
3) Authorization for Release of Health-Related Information, and
4) Consumer Privacy Notice