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Documents needed to file a claim under the long-term disability (LTD) benefit
Long-Term Disability Benefits Application (Employee’s Report, Employer’s Report, Physician’s Report, Authorization, and Disclosure)
Other documents to complete:
- Long-Term Disability Payment Options
- Job Physical Demands Form
- Education, Training, and Work History
- Rehabilitation Survey
- Functional Capacity Estimate
- Other Income Questionnaire
- Functional Capacity Evaluation
- Resources Questionnaire
- Mental Health Supplemental Questionnaire
- Description of Functions
- Social Security Information Disclosure
- Benefit Agreement
- Authorization to Request Medical Information
