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Commonly Required Types of Long-Term Disability Application Forms

Commonly Required Types of Long-Term Disability Application Forms

Employer-sponsored long-term disability plans normally must follow ERISA, a federal law that provides certain standardized requirements and procedures for these plans. Although ERISA does not require that insurers use specific forms for processing long-term disability claims, there are some common forms that claimants typically must complete in order to apply for long-term disability benefits.

For example, your employer’s human resources department should have a claim form that you initially would complete to apply for long-term disability benefits. If your employer does not have a form, you should be able to get one by contacting your long-term disability benefits provider or insurance company or look online for access to the form.

Most applications require you to complete a section of the form entitled “Employee’s Statement” or something similar. Generally, you must provide the following information on this form:

  • Identifying information, such as name, date of birth, Social Security number, address, and telephone number
  • Contact information for immediate family members
  • Work and educational history
  • Date of the injury or illness that led to your disabling condition
  • Last date that you worked
  • Medical diagnoses, symptoms, and resulting impairments
  • All medical providers and their contact information
  • All prescribed medications and their dosages
  • Any other forms of income that you may be eligible to receive, such as Social Security disability benefits or worker’s compensation benefits

Your employer generally also is responsible for completing their portion of the form. The information that they must provide typically includes the date of your hire, the effective date of your insurance coverage, the date that you last worked, insurance benefits and income that you are eligible to receive, title of your position, and a description of the requirements of your position.

Since a determination of your eligibility for long-term disability benefits is based on your medical conditions and resulting impairments, your doctor will need to complete a statement, as well. This statement contains information about all of your medical diagnoses, your prognoses, symptoms and effects of your medical conditions, the source of your illness, injury, or medical conditions, dates of treatment, referrals to specialists, and the dates and descriptions of any surgical procedures or other treatments that you have undergone. The doctor also can provide information about the extent of your impairments and how they limit your ability to work or perform other normal activities. It can benefit you greatly to get legal advice about all the potential means of building and maintaining the most effective ERISA long-term disability claim possible and guidance as to the pitfalls to avoid. Bonnici Law Group provides skilled, aggressive legal representation on a regular basis for individuals who are seeking long-term disability benefits under insurance policies governed by ERISA. Our priority is to represent your interests and protect your rights to the benefits that you deserve. Call us at 619-259-5199 and schedule an appointment to meet with us about your case today.

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