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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
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