Submitting Short Term Disability Claims

To submit a disability claim, you must complete and send a Short-Term Disability Claim Form (PDF) to the Fund Office.

The employer must complete the employer section on the front page, confirming employment and providing information about gross weekly wages and last dates worked and paid.

The employee must complete the employee section, also on the front page, providing personal information, work and disability dates, an explanation for the disability and any necessary details of an accident or injury, if applicable.

A physician who can provide the medical explanation for the disability and supply certification dates must complete the back of the form.

A claim cannot be processed unless all information requested on the claim form is provided. You must submit a short-term disability claim within one year of the start of disability in order for the claim to be processed.

Disability benefits are paid by the Fund Office. Mail or fax your completed claim form to:

Complete information on how to file a claim for Short Term Disability benefits is in your Summary Plan Description.