Disability Insurance Program Quick Reference Chart - Refer to this chart for answers to commonly asked questions from HR, Benefits, and Payroll Representatives.

• For State Agencies, School Districts, Charter Schools, DTCC, and DSU 

• For University of Delaware and Delaware Solid Waste Authority 

Human Resources/Payroll Disability Insurance Program Checklist  - Use this checklist if your employee is going to be out of work due to an accident, illness, or pregnancy for more than 30 calendar days to ensure that the employee receives all the required documentation and information.

Workers’ Compensation Checklist 

Hartford's Physical Demands Analysis (PDA) Form 

Short Term Disability Form Letter, Employee Acknowledgement and Claim Filing Checklist, Guidelines & Activity Log  - Required information to be provided to all employees by the 5th calendar day of their absence from work.

• Important - It is suggested that you download and resave the form with a new file name. The PDF Fillable Short Term Disability Form Letter is customizable. In addition to personalizing the participants information and HR/Benefits Representative contact information on the cover page, the checkboxes on page numbers 11 and 12 will indicate whether parental leave or workers' compensation is applicable to the participant; if not applicable, the content is removed. Please Note: Chrome is the suggested internet browser. Other browsers may not support the interactive PDF.

Exhaustion of STD Benefit Communications  - If an employee has not returned to work by the 20th week of their STD benefit period (6 weeks before the exhaustion of the employee’s STD benefit period), regardless of whether the employee’s claim is in an approved status or has had their STD claim extended through the 182nd calendar day of disability, provide the employee with the Exhaustion of STD Benefit communications for the purpose of obtaining the employee’s intentions of returning to work, retiring, or becoming a Long Term Disability beneficiary and for escrowing sick leave and annual leave for a 6 month period and for benefit elections for while on approved LTD.

• Important - It is suggested that you download and resave the PDF Fillable document with a new file name. Pages 1 and 8 are customizable and allow you to personalize the participants information and HR/Benefits Office contact information. Please Note: Chrome is the suggested internet browser. Other browsers may not support the interactive PDF.