Disability Claim Reporting
About Disability and Paid Family Leave Claims Reporting
Download and complete the necessary form(s) from the list below:
Disability Claim Forms:
Additional disability claims forms:
For Paid Family Leave Claims:
In all cases, the employer and employee each have portions of the documents that need to be filled out with medical practitioners sometimes being required as well.
The completed form(s) can be sent to us via e-mail at email@example.com; fax at 570-825-0611; or mail at:
P.O. Box 1368
Be sure to sign and date the document(s) before returning to us.
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