Sec. 125
Disability (Salary Protection) Reliance Standard Claim Form
Posted on Wednesday, November 2, 2005
Disability and Wellness claim form.pdf
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.