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Get and Sign the Hartford Disability Forms Online 2015-2022
Premium Waiver benefit. Be sure to provide
any necessary attachments (see Section K)
Employee's Statement - to be completed by the employee who is applying for Long
Term Disability benefits. Please attach a copy of the employee's driver's license.
Section
II
Section
III Authorization to Obtain Information - to be signed by the employee.
Section
IV Attending Physician's Statement - to be completed by the physician who is treating
the employee.
Please fax or mail the completed application...
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