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UNUM CL-1104 2024-2025 free printable template

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This form is used to evaluate eligibility for short term disability benefits through Unum Group and its subsidiaries, including necessary sections for the employee, employer, and attending physician
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People Also Ask about

How long does it take to review my claim? For most Short Term Disability claims, a payment decision will be made within 5 business days after Unum receives the completed claim. If the medical condition is more complicated, however, the review of the Short Term Disability claim could take up to 30 days.
Contact us Do you need to check the status of your claim or leave? Or do you just have questions about your policy? We can help. Call us at 866-679-3054 (8 a.m. to 8 p.m. ET, Monday through Friday) if you have any questions about your Unum coverage.
When should I file a claim? Disability claims should be submitted as soon as possible to ensure a claim decision is made in a timely manner. However, you should submit a completed claim form within 90 days after the loss begins.
When should I file a claim? Disability claims should be submitted as soon as possible to ensure a claim decision is made in a timely manner. However, you should submit a completed claim form within 90 days after the loss begins.
How do I file a claim? Online Claims can be filed on the Unum Website here. Claim Forms are available from your employer or here to download and print from the Unum Website. Completed claim forms can be mailed or faxed (1-800-447-2498) to Unum.
You can cover up to 65% of your weekly income. This is the number of days that must pass between your first day of a covered disability and the day you can begin to receive your disability benefits. Your benefits would begin after you become disabled for 7 days.
How long does it take to review my claim? For most Short Term Disability claims, a payment decision will be made within 5 business days after Unum receives the completed claim. If the medical condition is more complicated, however, the review of the Short Term Disability claim could take up to 30 days.
For most Short Term Disability claims, a payment decision will be made within 5 business days after Unum receives the completed claim. If the medical condition is more complicated, however, the review of the Short Term Disability claim could take up to 30 days.
Short Term Disability Insurance This benefit can pay a portion of an employee's compensation while they are out of work due to a covered injury, sickness or childbirth. Benefits can last for up to several weeks.

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