A&S (ACCIDENT AND SICKNESS)
Weekly Disability Benefit
If you are actively employed and cannot work due to a non-work related illness or accident, you are entitled to a weekly disability benefit according to your plan policy.
Please follow these simple procedures and make sure your disability form is fully completed. Uncompleted form will cause a delay in processing.
- Please have your employer complete their section of the claim form. MAKE SURE THE FIRST DATE YOU WERE UNABLE TO WORK IS WRITTEN. FORM MUST BE SIGNED AND DATED.
- The employee’s section must be completed entirely, dated and signed. If disability is due to an accident/injury, you must indicate HOW, WHEN AND WHERE accident/injury occurred. You are asked to provide a copy of the emergency room report or the initial medical history office notes. Police report is needed when disability is due to a motor vehicle accident.
- Your attending physician must complete the physician section. If a time frame can not be given as to when you could return to work, please have physician give an estimated date (ex. 2weeks), otherwise you will be required to complete a supplemental form on a weekly basis. PHYSICIAN MUST SIGN, DATE AND INCLUDE THEIR TAX ID NUMBER.
- After your first check, we may request that your physician fills out a supplemental form, especially when an estimated return to work time is not given.
All forms must be completed and received in our office by TUESDAY, in order to receive a check that week.