Wisconsin Retirement System participants applying for a disability retirement benefit need two physicians to complete this report certifying that they meet the WRS definition of disabled under section 40.63 of the Wisconsin Statutes. The form is not posted online: ETF mails it in the disability packet with the ET-5302 estimate and application, along with return envelopes for the physicians.
Two licensed physicians (MD or DO) each complete a report, and one must specialize in the area of the disability. The member completes their portion first, and the employer separately certifies that employment ended because of the disability.
Download the current version from the source each time; forms change without notice.
Disability Medical Report
If your copy of the form is a fillable PDF, upload it once and Vero Documents fills it from the visit note and the chart, ready for you to review and sign. Download, print, or email the finished form, with the patient’s consent.
A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.
Vero is not affiliated with, or endorsed by, the agencies and insurers listed here. Read our editorial policy.
Two licensed physicians, either MD or DO, must each complete a Disability Medical Report stating the member is disabled. One of the two must specialize in the area of the disability, and ETF cannot approve the benefit without both reports.
No. The member requests a disability retirement estimate, and ETF mails a packet containing ET-5302 and two medical reports with return envelopes. The member completes their portion of each report and gives one to each physician, who returns it directly to ETF.