Submit a Disability Claim
Instruction on Submitting a Disability Claim Online:
- Go to: http://www.prudential.com/gi
- Click the "Employees" tab on the right of the screen
- Under "Service Center" click Employee Forms
- Under "Self Service" click Disability Claim Submission
- Click "Here" to submit disability claim
- Enter policy number "61605", and State of Residence, then click "next"
- Division Name/Work Location: enter the department you work in, and click "next"
- Complete the following:
- Employee information
- Client Employee ID: Enter Social Security Number
- Other Income & Workers Comp
- Job Information
- Primary Care Physician
- Medical Information
- Disability Information
#Branch number for STD & LTD is 00002
- After completing the online disability clain, click the "Submit" button.
- Finally, click the following link: http://www.prudential.com/view/page/public/12165
#Under "Disability and Absence Claims" select the "Attending Physician
Statement" form. Print the physician's form, submit to your healthcare
provider for completion and submit to the HR Benefits Office.
If additional assistance is needed, please contact Regina Barnett at 404-413-3334, Fax: 404-413-3335 or e-mail: firstname.lastname@example.org . You may also call Prudential at 1-800-842-1718 fax: 1-877-889-4885.