How to Complete a Short-Term Disability Claim Form

by Jack Ori ; Updated July 27, 2017

If you are temporarily unable to work due to injury or illness, you can file for short-term disability. Some insurance companies handle short-term disability claims privately; you can also file through your state disability bureau. You must get certification from a medical doctor to qualify for short-term disability unless you do not visit doctors for religious reasons, in which case you can get certification from a spiritual healer.

Step 1

Obtain a short-term disability form from your state's department of disability benefits or from your insurance provider. You may be able to download this form from your provider's website.

Step 2

Fill out the first part of the form. Provide personal information such as your name, address and Social Security number as well as information about the disability such as when it began, how it interferes with your ability to work and how long you have been out of work.

Step 3

Give the form to your employer if your state or insurance provider requires you to do so. Your employer must confirm details regarding your salary, employment status and last day worked.

Step 4

Bring the form to your physician. Your physician must provide information about your diagnosis and how long you will be out of work.

Step 5

Check the form over. If anyone has not signed his portion of the form, return it to him to sign. Make a copy of the form.

Step 6

Send the original form to your insurance provider or state disability bureau. Check your mail for a response within two to four weeks. If you are approved, you will receive disability payments for the duration of your disability.

About the Author

Jack Ori has been a writer since 2009. He has worked with clients in the legal, financial and nonprofit industries, as well as contributed self-help articles to various publications.

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