Printable Forms: Great West Life Short Term Disability
Short Term Disability Income Benefits
- The plan member must complete the Employee Statement in order to claim for Short Term Disability benefits. The plan member’s physician must complete the Attending Physician’s Initial Statement Disability Income Benefits form.
Life Waiver – Employee’s Statement
- This form is used to claim premium free continuance of life insurance benefits. The plan member must submit this completed form at least eight (8) weeks prior to the end of the LTD elimination period.
Application for Group Short Term Disability Benefits - Employer’s Statement
- The plan sponsor must complete this form in order for the employee to claim for Short Term Disability Benefits
Employer Life Waiver of Premium - Notice of Claim
- This form is used to claim waiver of premium. This form is used to claim premium free continuance of life insurance benefits. The plan sponsor must submit this completed form at least eight (8) weeks prior to the end of the LTD elimination period.
