Get Weekly Disability Benefits

This guide will assist you in completing the Weekly Disability Benefits form accurately and efficiently. By following the instructions provided, you can ensure that your claim is processed without unnecessary delays.

Follow the steps to complete your Weekly Disability Benefits form.

1. Press the ‘Get Form’ button to access the Weekly Disability Benefits form and open it in the online editor.
2. In Part I, input your name, birth date, and address. Indicate whether this claim is based on an accident and provide details such as the date of the accident and your job title.
3. Complete sections regarding your employment and disability history. This includes questions on previous job duties, social security number, and whether you are currently receiving any other benefits.
4. Ensure you attach the necessary documentation, including the AUTHORIZATION FOR USE IN OBTAINING INFORMATION form signed by you and the ATTENDING PHYSICIAN STATEMENT filled out by your healthcare provider.
5. In Part II, if you are the employer, complete the remaining sections with your company's information and sign accordingly, ensuring that all questions are answered.
6. Once all parts of the form are filled out, review the document to confirm that all the information is correct and complete.
7. Finally, save your changes, download, print, or share the completed form as needed before submitting to Reliance Standard Life Insurance Company.

Start completing your Weekly Disability Benefits form online today!