Submit a long-term, short-term or early referral services claim form.
Apply for disability benefits
Your web browser (Chrome, Internet Explorer, Firefox, etc.) cannot accommodate the submission of a completed employer’s statement. If the form is completed in your web browser, the information will appear on your screen but won’t be captured when you submit the form.
To ensure we get your information, save a copy of the applicable employer’s statement to your computer before filling it out.