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Gtqlll to you. Have your Employer complete the Employer s Report of Claim. Submit the completed A. Employee s Disability Benefits Application B. Group Disabitity Ctairn Filing Instructions Not for use when filing for Physician s Expense BenefTts Complete mployee s Disability Benefits Application in full* Have the treating physician complete the Attending Physicians Statement and r. mployers Report of Claim C. Attending Physician s Statement To the address below or submit via our tol -f ree...

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For pdfFiller’s FAQs

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