D.A. Townley  -  Plan Administrators Iron Workers Union Local 97 International Association of Bridge, Structural, Ornamental and Reinforcing Iron Workers 
 

health
benefits

        
 
 
 
 
 
 
 
 
 
 
 
 
   
        
   
 
 
 
 
   
 
 
 
 
   
 

Long Term Disability - Statement of Employer

Use
The employer completes the Statement of Employer Regarding Employee Group Long Term Disability Claim to provide information to the insurer regarding the Member's Long Term Disability claim.


Information Needed to Complete the Form
To complete the form the employer must include:

  • Information regarding the disabled employee
  • Other benefits that the employee may be eligible for
  • Any information that may aid in the consideration of the claim.


Notes
Questions on completing the form should be directed to the Plan Administrator.

Completed forms should be forwarded to the Plan Administrator.



 

Form Link
 

Related Links
Statement of Claimant for Long Term Disability Benefits
Attending Physician's Initial LTD Benefit Statement
Application for Disability Credits
 
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