Unum uses this 15-page form to open a claim under an individual disability income policy. The physician or treating provider primarily responsible for care completes the Attending Physician Statement on pages 12 to 14, covering a normal pregnancy or other conditions, functional capacity, prognosis and other treating providers. The insured supplies an individual statement, an occupation description and a signed authorization.
The physician or treating provider completes sections A to F of the Attending Physician Statement and signs section F. The insured completes the Individual Statement (pages 4 to 7), the Occupation Description Statement (pages 8 to 10) and the authorization.
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Individual Disability Claim Form
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CL-1020 is for individual disability insurance policies. It routes to Unum's individual disability claims fax line rather than the group Benefits Center line, and it includes an Occupation Description Statement that the insured completes.
Specific physical restrictions, physical limitations, behavioral health restrictions and behavioral health limitations, each with from and to dates, plus the diagnostic or clinical findings supporting them and a treatment plan with medications. If there are none, initial section C and go to section D.