Sec. 125
Disability (Salary Protection) Reliance Standard Claim Form
Posted on Wednesday, November 2, 2005
File icon Disability and Wellness claim form.pdf
Size: 87 KB
For disability claims due accident or illness. This is also the claim form used for Medical Income Benefit.
Form for disability due to accident or illness or for a doctor bill benefit (participant must be disabled for a least one full day and sees a doctor on the day of disability). The form will need to completed by employee, doctor and employer.
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