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Attending Physician Supplementary Statement
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If the employee is making a claim, the employee's physician must complete this supplementary statement.
Form Number: 14075 |
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AWI/STD/ASO-STD Disability Claim Form
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If an employee is making a disability claim, they will need to provide us with a statement. The form also includes sections that will need to be filled out by the employer and the employee's physician.
Form Number: 14037 |
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Claimant Supplementary Statement
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If the employee is making a claim, they must complete this statement.
Form Number: 14077 |
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Disability Claim Form
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The employee will need to fill out this form if making a disability claim.
Form Number: 83730 |
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First Alert Employee Absence Form
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If the employee is making a claim, the employee and the employer must fill out the appropriate sections of this form.
Form Number: 14093B |
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Group Life/Accidental Death Notice of Claim
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If the insured is deceased, the claimant, the employer and the deceased's physician must fill out specified sections of this form.
Form Number: 14073 |
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Notice of Critical Illness Claim Form
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If you are making a claim for critical illness insurance benefits, you will need to fill out this form. It also includes a section to make a claim for return of premium on death if covered under the policy.
Form Number: 14003 |
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Spouse Disability - Notice of Claim
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If your employee is making a spousal disability claim, they will need to provide us with a statement. The form also includes sections that will need to be filled out by the employer and the treating physician.
Form Number: 14080 |
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