Claim Statement Documents

by ryan on February 23, 2017


Claim Statement Documents


You will need to fill out all the items that are listed on the form, in the area that says “Claim Statement of Employee“, and go on and sign that part of the form. You need to get this as accurate as possible and make sure that the dates are correct. Anything that is wrong or missing will slow down the process and delay a payment if they decide you are eligible.


Next you will have the portion where you will need to provide a Doctor’s certificate. Take this to the doctor who has told you that you are disabled and have them sign it. It can be by any of the following types of doctors who are licensed. Surgeon, podiatrist, dentist, chiropractor, psychologist, or even optometrist. You can even have a medical officer who is authorized and works at a US Government facility sign this form.
Other possible people who are allowed to sign the form for disability are a licensed nurse or midwife, or a midwife that is helping with disabilities that come as part of pregnancy or even childbirth, or possibly a nurse practitioner.

In some cases a person may be too disabled to actually fill this form out themselves; in that case you can have someone help you out. This should need to have another form that will give you the ability to do so, but calling will provide you with the help you need in this process.
There will be times that someone may be under the care of someone who is considered to be a religious practitioner. You can get a form that is the DE 2502, or a Practitioner’s Certificate that will need to be filed with your claim. It will need to be signed by that practitioner; no faxes will be permitted for this form.

In the case that you may only be filing for a temporary benefit that goes along with a worker’s compensation claim you will not need to provide that certificate from your doctor. You only have 49 days from the day that you are disabled to file this form, but do not send it in prior to nine days after you were disabled either.

Printable – Claim Statement Documents




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