Short Term Disability Claim Form

Filing Instructions

Have you…

1. Completed the Claimant Information Section in full?

2. Had the physician treating you complete the Attending Physician’s Section, and had it

returned to you?

3. Had your Employer complete the Employer Information Section, and had it returned to

you?

4. Read, signed and dated the Authorization for Release of Information?

Submit the completed statements to the address below or

fax to 1-(207) 591-3048.

All portions of these forms must be completed

in order to expedite your claim.

If you have any questions when completing this form,

please call:

Toll-Free Phone Number 1-(866) 701-2673

WEA Trust

Disability Claims Department

One Riverfront Plaza

Westbrook, Maine 04092-9700

0 votes

Parent category: Legal