• Basics for Medical Providers
• Becoming an Independent Medical Examiner
• How to Order Claim Forms Online
• Forms and Publications
• Future Disability Insurance Automation
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How to order a Claim Form Online

You may order Disability Insurance (DI) or Paid Family Leave (PFL) claim forms online or download the online DI claim form. However, we recommend that you and the patient read instructions on how to file a Disability Insurance claim form prior to filling out the claim form.

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Claim forms may also be ordered by calling DI or PFL toll-free.

The Doctor’s Certificate (page 3) and the “Claim Statement of Employee” (pages 1 and 2) for Disability Insurance must be mailed together in the same envelope to one of the addresses listed below.

Disability Insurance Office Locations