---
title: Disability Insurance Claim Form Template with Physician Statement | Paperform
description: Comprehensive disability insurance claim form template with physician statement, employment verification, income documentation, and functional capacity assessment sections for streamlined claims processing.
url: "https://paperform.co/templates/disability-insurance-claim-form"
type: static
generatedAt: "2026-03-28T00:43:40.876Z"
---

[← Back to free form templates](/templates/)    ![Disability Insurance Claim Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/disability-insurance-claim-form.png)
    [Preview](https://_preview.paperform.co/ai-template/disability-insurance-claim-form) [Use this template for free](/create?ai-template=disability-insurance-claim-form)    [Industry-Specific Forms](/templates/category/industry-specific/) [Insurance](/templates/industry/insurance/) [HR Manager](/templates/role/hr-manager/)[Insurance Agent](/templates/role/insurance-agent/)[Claims Adjuster](/templates/role/claims-adjuster/)[Underwriter](/templates/role/underwriter/)     About this free form template
Filing a disability insurance claim can feel overwhelming when you're already dealing with health challenges. This **disability insurance claim form template** brings together all the required documentation—from physician statements to income verification—into one organized, professional workflow.

Built for insurance providers, third-party administrators, and employers managing disability benefits, this template ensures claims are submitted with complete information the first time, reducing back-and-forth delays and helping claimants receive decisions faster.

The form collects essential claimant information, detailed medical statements from attending physicians, employment and income verification, and a thorough functional capacity assessment. Each section uses conditional logic to show only relevant follow-up questions, keeping the experience clear and reducing form abandonment.

**How Paperform helps streamline disability claims:**

Insurance teams can customize this template to match their specific policy requirements and benefit structures. Use calculations to verify income thresholds, conditional logic to route claims by disability type, and file uploads to securely gather supporting medical records and tax documents. Success pages can provide next steps and expected timelines, setting clear expectations from the moment of submission.

Connect this form to your claims management system through [Stepper](https://stepper.io) to automatically create case files, notify adjusters, send acknowledgment emails, and trigger review workflows based on claim complexity. For claims requiring additional signatures or authorizations, [Papersign](https://papersign.com) lets you route release forms or consent documents directly from the submission data.

Whether you're processing short-term disability, long-term disability, or Social Security Disability Insurance (SSDI) supplemental claims, this template provides the structure and flexibility insurance professionals need to manage claims efficiently while maintaining compliance and compassion throughout the process.
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