EDIT MAIN
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Please make sure to provide a doctors note to Human Resources with the dates that you will be off of work.

If you have a voluntary disability plan, please complete any necessary forms and Human Resources will complete any necessary Employer section(s) of the form.

**REMINDER: YOU WILL NEED A DOCTORS NOTE RELEASING YOU (WITH ANY MODIFICATIONS) BEFORE YOU CAN RETURN TO WORK.**

We do NOT pay into State Disability.

www.americanfidelity.com

Ph:(800)662-1113

Fax: (800) 818-3453


Please provide a doctors note to Human Resources with the dates that you will be off of work and complete your section of the disability form. Human Resources will complete the Employer's Report of Claim section of the form. We will send the documentation directly to American Fidelity.

**REMINDER: YOU WILL NEED A DOCTORS NOTE RELEASING YOU (WITH ANY MODIFICATIONS) BEFORE YOU CAN RETURN TO WORK.**

The Standard
Individual Disability Service
http://www.ctamemberbenefits.org/thestandard

P: 800.247.6888

P: 800.378.6057 (In NY)
F: 971.321.5829

Please contact The Standard to file a claim and request any applicable forms.

Please provide a doctors note to Human Resources with the dates that you will be off of work and complete your section of the disability form. Submit any applicable forms to the Human Resources to be completed by the employer and we will send the documentation directly to The Standard.

**REMINDER: YOU WILL NEED A DOCTORS NOTE RELEASING YOU (WITH ANY MODIFICATIONS) BEFORE YOU CAN RETURN TO WORK.**

800.992.3522

www.aflac.com

Please contact an Aflac Representative to file a claim and request any applicable forms.

Please provide a doctors note to Human Resources with the dates that you will be off of work and complete your section of the disability form. Submit any applicable forms to the Human Resources to be completed by the employer and we will send the documentation directly to Aflac.

**REMINDER: YOU WILL NEED A DOCTORS NOTE RELEASING YOU (WITH ANY MODIFICATIONS) BEFORE YOU CAN RETURN TO WORK.**