Forms
| Title | Purpose | Action |
|---|---|---|
| EFT Setup for Long Term Disability Claim Payments (All states except NY) | Used to request the electronic funds transfer (EFT) of Long Term Disability claim payments. |
Download |
| EFT Setup for Long Term Disability Claim Payments (NY) | Used to request the electronic funds transfer (EFT) of Long Term Disability claim payments. |
Download |
| Long Term Disability Claim Packet (All states except NY) | Use this packet to file a claim for a Long Term Disability plan issued outside of the state of New York. |
Download |
| Long Term Disability Claim Packet (NY) | Use this packet to file a claim for a Long Term Disability plan issued in the state of New York. |
Download |
| New York Paid Family Leave Bonding Leave Packet | Use this packet for file a claim for bonding leave under Paid Family Leave in New York. |
Download |
| New York Paid Family Leave Care of Family Member Packet | Use this packet for file a claim for care of family member leave under Paid Family Leave in New York. |
Download |
| New York Paid Family Leave Military Leave Packet | Use this packet for file a claim for military exigency leave under Paid Family Leave in New York. |
Download |
| Short Term Disability Claim Packet (All states except NY) | Use this packet to file a claim for a Short Term Disability plan issued outside of the states of New York. |
Download |
| Short Term Disability Claim Packet (NY) | Use this packet to file a claim for a Short Term Disability plan issued in the state of New York. |
Download |
| State Disability Claim Packet (NJ) | Use this packet to file a claim through a New Jersey State Disability plan. |
Download |
| State Disability Claim Packet (NY) | Use this packet to file a claim through a New York State Disability plan. |
Download |