Disability

A "one stop shop" best describes Disability Management, which takes an integrated approach to handling employee issues related to:loyee issues related to:

Non-occupational injuries/illnesses;
Short-term disability;
Long-term disability;

And under the disability umbrella, issues related to:

The Family and Medical Leave Act (FMLA);
Americans with Disabilities Act (ADA) accommodations for employees, applicants and citizens;
Transitional duty and return to work;
And the coordination of work/fitness exams.

Documents for HR Liaisons:

Request For Service/Intake Form
For questions on completing the forms, call 602-506-1010, press 1 to continue in English, then 2 and then 3. Should you require ADA accommodation for a phone call, dial 602-506-1010, press 1 to continue in English, then 5 and then 2.
Employer Long Term Disability (LTD) Forms
Click on Employer forms to download. There is no electronic version of the employer forms. If the employee is on STD w/Sedgwick, complete only the first page; otherwise complete all forms and include the essential functions of the employee's job.

Document for Employees:

Certification of Health Care Provider - Department of Labor Form WH-380
Use this form to request leave under the Family and Medical Leave Act.
To request an accommodation under the Americans w/Disabilities Act (ADA), dial 602-506-1010, press 1 to continue in English, then 5, then 2.
Donation of Leave Form

TTY number for assistance from Disability Management is 602-506-1908

Short-Term and Long-Term Disability

Short-Term Disability documents for employees

Please note: The Short-Term Disability Claim Form Packet below is for information only. To apply for short-term disability benefits through Sedgwick, CMS, call 1-800-599-7797 or apply online by clicking here: www.vpainc.com

Short-Term Disability Brochure
Short-Term Disability Highlights
Short-Term Disability Summary Plan Document
Includes an introductory letter, an authorization for release of information and a right of reimbursement form
Short-Term Disability Calculator for 2008 Rates (requires MS Excel)

Long-Term Disability documents for employees

Please note: Your disability benefits specialists at Sedgwick will work with you directly when applying for long-term disability. The documents below are for information only.

Long-Term Disability Booklet

Long-Term Disability documents for employees who have never been on short-term disability with Sedgwick:

Long-Term Disability Booklet
Employee Long Term Disability (LTD) application materials
To download the forms, click on Employee forms. There is no electronic version of the LTD claim forms. If you would like an LTD packet mailed to you, call 602-506-1010, press 1 for English, then 6.