Disability Insurance Templates

This document is a questionnaire form called the Oswestry Disability Index. It is used to assess the level of disability and pain in individuals with lower back pain. This type of document helps healthcare professionals to determine the impact of back pain on daily activities and develop appropriate treatment plans.

Use this form to supply the Social Security Administration (SSA) with a signed statement when applying for Social Security benefits or Supplemental Security Income (SSI).

This form is used for reporting annual income for disability insurance elective coverage in California.

This Form is used for applying for Supplemental Service-Disabled Veterans Insurance (SRH).

This form is used for reporting a disability in the state of California. It is typically completed by a physician to provide information about an individual's disability and its impact on their ability to work or perform daily activities. The report is often required for various disability benefits or accommodations.

This form is used for reporting the termination of temporary total disability (TTD) or temporary partial disability (TPD) in the state of Indiana.

This Form is used for employees in Canada to claim disability insurance benefits. It requires the employee to provide a statement about their disabilities and policy information.

This Form is used for disability assessment in the Northwest Territories, Canada.

This document is used for requesting an appeal for disability benefits in the state of Ohio. It provides individuals with the opportunity to present their case and provide additional information to support their appeal.

Download this form if you wish to make an online appeal of a Social Security Administration (SSA) decision regarding your benefit request.

This form is used for verifying the coverage of workers' compensation and disability insurance in the state of New York.

This Form is used for issuing a judgment on disability matters in the state of Kentucky.

Individuals may use this type of document as a reference to dispute an unsatisfactory ruling of an insurance company regarding a long-term disability.

An employee who was denied proper insurance coverage to protect their financial standing during a temporary inability to do their job as a result of injury or illness may use this sample as a reference.

This form is used for annual statement reporting by domestic life and disability reinsurers in Arizona. It serves as a worksheet to gather relevant information for reporting purposes.

This form is used for requesting long-term disability coverage for a period of 24 months, with direct payment option, in California.

This form is used for Long-Term Disability Insurance under the Public Service Management Insurance Plan in Canada. It is available in both English and French.

This Form is used for requesting a waiver for Life and Long Term Disability Insurance in the state of Iowa.

This form is used for making corrections to the Sebb Long-Term Disability (Ltd) Insurance application in Washington state.

This form is used for employers in Florida to provide a statement of disability for their employee. It helps in documenting and verifying the disability claim made by the employee.

This is a state of California form to request, by mail, worker-funded benefits to eligible workers who have a full or partial loss of wages due to disabilities that are not work-related.