UFCW Local 1776 Benefit Funds
Short-Term Disability
Short-Term Disability Benefits
You may be eligible to receive weekly disability (wage-loss) benefits for a period of time during which you are totally and continuously unable to work due to an injury or illness.
How to File a Disability Claim
You must file a claim with the Fund Office within seven days from the date you become disabled by following the procedures identified below. If you do not file the claim within seven days from the onset of the disability, a disability benefit will not be paid for the period from the onset of the disability through the date on which you actually file the claim with the Fund Office.
You must also remember to notify your employer of your injury or illness immediately so that your employer can complete the Health and Accident Report form and return it to the Fund Office within four days of your absence due to your disability. If your employer does not submit the Health and Accident Report form to the Fund, the payment of your disability benefit may be delayed.
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To file a claim for a disability benefit with the Fund Office, you may do either of the following: call the Fund Office Disability Hotline to report your disability by telephone; OR submit a Disability Claim Form in writing to the Fund Office.
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Steps to File a Claim
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Obtain an "Employee Accident & Sickness Disability Claim Form" ("Employee Claim Form") from your employer, from the Fund Office, or by downloading a copy.
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Complete the Employee Claim Form and send it to the Fund Office.
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Have your physician complete the form titled “Physician Accident & Sickness Disability Claim Form” (Physician Claim Form") and send it to the Fund Office.
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Submit the completed claim form to the Fund Office within seven days of the onset of the disability.
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Your claim will not be processed for payment until the Fund Office receives the completed Employee Claim Form and the completed Physician Claim Form.
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​It is critical to remember to report a disability relating to any illness or injury, whether work-related or not, to the Fund Office (using either the Disability Claim form or the Fund Office Disability Hotline) within seven days of the onset of your disability. Failure to comply with this deadline may result in the denial of some or all of your disability benefit.