TOTAL AND PERMANENT
DISABILITY CLAIMS (NEW YORK ONLY)

There are time periods for applying for this benefit - check your policy and certificate. Remember to complete any applicable Employer's section(s) before distributing forms to employees.

To submit a claim, you need to distribute the following forms to the employee:
1) Claim form
2) Attending Physician's Statement of Disability
3) Authorization for Release of Health-Related Information
4) Consumer Privacy Notice