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Fill Out Your Pearl Carroll Disability Claim Form

The Pearl Carroll Disability Claim form is a document designed to help individuals apply for disability income benefits. It requires applicants to provide personal information, details about their disability, and records of medical treatment received. Completing this form is essential for accessing much-needed financial assistance during periods of disability; interested individuals can start the process by clicking the button below.

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Article Structure

The Pearl Carroll Disability Claim form is designed for individuals seeking to claim disability income benefits. This form encompasses various components crucial for processing a comprehensive claim efficiently. It begins with a Member Statement, requiring the claimant to answer a series of questions about their personal information, including their medical history, nature of disability, and the precise dates of their treatment and inability to work. Importantly, a complete list of all healthcare providers and hospitals that have treated the individual for the asserted disability must be submitted. Claimants are also prompted to ensure that the Medical Provider's Statement is filled out fully by their healthcare professional, thereby endorsing their medical condition. Furthermore, the form stipulates the necessity of signing both the Member Statement and the Authorization for Release of Information, which permits the sharing of medical records with the relevant parties to evaluate the disability claim. The form specifies the completion and return process, including submission options via mail, email, or fax to Pearl Carroll & Associates LLC, emphasizing the necessary steps should the claimant recover or return to work. Detailed instructions clarify that any change in the individual's work status must be communicated promptly to facilitate accurate benefit management. This thorough framework aims to ensure that everyone entitled to such benefits can navigate the claims process seamlessly.

Pearl Carroll Disability Claim Example

STATEMENT OF RECOVERY OR RETURN TO WORK

DISABILITY INCOME CLAIM INSTRUCTIONS

(PLEASE DETACH THIS NOTICE BEFORE MAILING AND KEEP FOR FUTURE REFERENCE)

Please answer all questions on the Member Statement on your Disability Income claim form

Please provide a complete List of Providers/Hospitals that treated you for this disability.

Date and sign both the Members Statement and the Authorization for Release of Information.

Please have your Medical Provider complete both pages of the Medical Provider’s Statement.

Please see that the completed form is returned to:

Pearl Carroll & Associates LLC

Disability Claims Unit

12 Cornell Road

Latham, NY 12110

If you recover or return to work, please notify Pearl Carroll & Associates immediately by completing and mailing this statement to the above address or emailing to Customercare@PearlCarroll.com.

If you have any questions concerning your request for Disability Income benefits, you may call the Office of the Administrator at 1-800-697-2732. The fax number is 518-640-8105. Please note that we will not confirm receipt of a fax for 24 - 48 hours.

Name: _______________________________________________________________________________

Mailing Address: _______________________________________________________________________

_______________________________________________________________________

Social Security No.: ______-______-________

Policy G-11628

I recovered:

I returned to work

Other (I.E. Returned to work light duty, another job etc):

Date:

Month/Day/Year

Date: _______________________ Signature: ___________________________________________

Email Address: __________________________________________________________________________________

CSEA DI ed 10/2016

CSEA MEMBER’S DISABILITY INCOME FORM

CLAIM TYPE:		Member Disability		Spouse-Coverage Disability				Non-Disabling Injury
		Hospital Benefit						Survivor Benefit
Member Name:	____________________________________					Date of Birth: ___________________________
Social Security # _____________________________________							Male	Female
Spouse Name:	____________________________________					Date of Birth: ___________________________
Social Security # ______________________________________							Male	Female
Mailing Address: _____________________________________________________________________									__________
		(No.)	(Street)						(Apt No.)
	_______________________________________________________________
		(City or Town)		(State)				(Zip Code)
Telephone No.: Home: (		)______________________			Em ployer (		) ________________ Height: ________			Weight ________
Employer’s Name: ___________________________________________________________								Normal Number of Hours Worked Per Week: ________
Employer’s Street Address: ______________________________________________________________________________________
		(No.)		(Street)			(City or Town)		(State)	(Zip Code)

Email Address: ____________________________________________________________________________________________________

What is the nature of your disability?__________________________________________________________________________________

Is disability work related? Yes	No		If yes, please attach a copy of the Employee Accident Report signed by manager
Is disability due to an Injury? Yes		No		If “Yes”, when? _______/______/________
						Mo .	Da y	Year
Where did it happen?__________________________________________________________
How did it happen? _______________________________________________________________
Date first treated for this disability:		_____/_____/_______
		Mo.	Day	Year
Date First Unable to Work: ______/______/______				Date Last Worked: ______/_______/_______
Mo.	Day	Year		Mo.	Day	Year

Have you attempted to return to your occupation since the date disability began? (If so, give details)

If returned to work or recovered, give date: _____/_____/______			Returned to work: Full Time:
Mo.	Day	Year	Part Time:
			If Part Time, # of hours per day _______
If not returned, when do you expect to? _____/_____/______
Mo.	Day	Year

Are your working a second job? If so, please provide the name and address of the company and the hours you are working.

**If disability is due to a Motor Vehicle Accident, please attach MV-104A Police Report**

** If treated in hospital or Urgent Care Center, please attach a copy of your discharge papers**

CSEA DI ed 10/2016

CSEA MEMBER’S DISABILITY INCOME FORM

Member’s Name ___________________________________ Member’s Social Security #________________________

Names and addresses of providers consulted and any other providers seen for treatment.

PLEASE PRINT – If you need more space, you may attach a sheet of paper with the additional names, addresses, and phone numbers. Be sure to include all providers, as any missing may delay your claim.

PHYSICIANS:

Name:			Name:

Address:			Address:

City:			City:

State:	Zip:		State:	Zip:

Phone:			Phone:

Name:			Name:

Address:			Address:

City:			City:

State:	Zip:		State:	Zip:

Phone:			Phone:

Name:			Name:

Address:			Address:

City:			City:

State:	Zip:		State:	Zip:

Phone:			Phone:

		HOSPITALS
Name:			Name:

Address:			Address:

City:			City:

State:	Zip:		State:	Zip:

Phone:			Phone:

		PHARMACIES
Name:			Name:

Address:			Address:

City:			City:

State:	Zip:		State:	Zip:

Phone:			Phone:

CSEA DI ed 10/2016

CSEA MEMBER’S DISABILITY INCOME FORM

Member Name _______________________________________ Member’s Social Security #__________________________

Please state your occupation: ________________________________________________

**Please attach a copy of your official job description**

Please fully describe all the duties of your occupation at the time you stopped working including the percentage of time spent on

each activity:

_____________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________________

What are your daily activities?________________________________________________________________

_________________________________________________________________________________________________________

Are you receiving or will you be eligible to receive benefits from:	Workman’s Compensation?	Yes	No
	Pension Plan?	Yes	No
	Another Group Insurance Plan?	Yes	No
	Individual Disability Income Policy?	Yes	No
	Social Security Disability?	Yes	No

If “Yes” insert policy number, claim number and address of insurance company or organization providing such benefits and amount of payment.

Policy No.

Claim No.

Name and Address

Amount of Payment

I declare that the answers on Page 1, Page 2 and Page 3 of this form are complete and true to the best of my knowledge and belief. I also agree that I will advise the New York Life Insurance Company of my return to any type of work and that I will return any payments to which I am not entitled by reason of my return to work or termination of my disability.

New York Residents: Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claim containing any materially false information, or conceals for the purpose of misleading, information concerning any fact material thereto, commits a fraudulent insurance act, which is a crime, and shall also be subject to a civil penalty not to exceed five thousand dollars and the stated value of the claim for each such violation.

Date: _____________	Member’s Signature _______________________________________________
MO/ DAY/YEAR	The Member or someone on his/her behalf must sign here and on the
	Authorization for Release of Information Form.
	Please see that the completed form is returned to:
	Pearl Carroll & Associates LLC
	12 Cornell Road – Disability Unit
	Latham, NY 12110
	Fax # 518-640-8105 or email to Customercare@PearlCarroll.com
	3

CSEA DI ed 10/2016

	Authorization for Release of Information
TO:	All providers of medical services and supplies, pharmacy related service organizations, prescription history database

suppliers, employers, insurance institutions, the Social Security Administration and other organizations.

I authorize release to New York Life Insurance Company or their representative, Pearl Carroll & Associates LLC, any independent claim administrators, consulting health professionals, pharmacy related service organizations and utilization review organizations with whom New York Life has contracted, information concerning health care advice, treatment or supplies provided the patient (including that related to mental illness and/or AIDS/ARC/HIV) and prescription records. This information will be used to evaluate claims for benefits.

In Oklahoma, the information authorized for release may include records which may indicate the presence of a communicable or non-communicable disease.

This authorization may be used for a period of 24 months from the date signed below unless sooner revoked. I may revoke this authorization at any time by notifying New York Life in writing at the address given on this form. My revocation will not be effective to the extent New York Life or any other person has already disclosed or collected information or taken other action in reliance on it. The information New York Life obtains through this authorization may become subject to further disclosure. For example, New York Life may be required to provide it to an insurance regulatory or other government agency. In this case, the information may no longer be protected by the rules governing this authorization.

A photocopy of this authorization and request form shall be as valid as the original. I know that I may request a copy of this authorization.

_____________________________________________	_________________________________
Patient’s Signature	Date
_____________________________________________	_________________________________
Print Name	Social Security No
______________________________________________	__________________________________
Address	City,	State	Zip
______________________________________________	__________________________________
Email Address	Phone Number

Medical Records Release to: Datafied Inc. 1210 N. Jefferson St. Suite P Anaheim, CA 92807

Please see that the completed form is returned to:

Pearl Carroll & Associates LLC

12 Cornell Road – Disability Unit

Latham, NY 12110

Fax # 518-640-8105 or email to Customercare@PearlCarroll.com

CSEA DI ed 10/2016

MEDICAL PROVIDER’S STATEMENT

(The patient is responsible for the completion of this form without expense to the Company)

Notice to Provider: Thank you in advance for your cooperation in completing this form on behalf of your patient identified below. We will consider this information in conjunction with other information gathered to determine the claimant’s eligibility for benefits according to his or her specific contract with us. We will periodically request that you provide updated information, records and chart notes to enable our evaluation of a continuing claim. In order for us to expedite our consideration of your patient’s claim, please fully answer each question and sign and date the form where indicated.

1.PATIENT’S NAME: ______________________________________________ SOCIAL SECURITY NO.: __________________

	(First)	(Middle)	(Last)
				DATE OF BIRTH: _____/_____/______
2.	CURRENT MEDICAL CONDITION(s):				(Mo) (Day)	(Year)
	PRIMARY DIAGNOSIS: __________________________________			ICD-10 CM CODE: _____________
	SECONDARY DIAGNOSIS: _____________________________			ICD-10 CM CODE: _____________
3.	DATE THAT SYMPTOMS FIRST APPEARED OR ACCIDENT HAPPENED:				______/_____/_______
					(Mo) (Day)	(Year)
4.	DATE THAT PATIENT FIRST CONSULTED YOU FOR THIS CONDITION:				______/_____/_______
					(Mo) (Day)	(Year)
5.	DATE YOU LAST TREATED THE PATIENT:				______/_____/_______
					(Mo) (Day)	(Year)
6.	IS THIS CONDITION RELATED TO PATIENT’S EMPLOYMENT?			YES	NO
7.	WAS PATIENT REFERRED TO YOU BY ANOTHER PRACTITIONER?			YES	NO

(If “Yes”, please provide the name and address of that practitioner): __________________________________________________

______________________________________________________________________________________________________________

8.OBJECTIVE FINDINGS (Include x-rays, lab results and clinical findings. If pregnancy, also give LMP and EDC):

____________________________________________________________________________________________________

9. HAS PATIENT BEEN HOSPITALIZED? YES NO (If “YES”, provide reason, hospital name and dates of

confinement): ________________________________________________________________________________

10.NATURE OF TREATMENT CURRENTLY BEING PROVIDED OR PLANNED: (Include dates and type of surgery

and any medications prescribed if applicable): ___________________________________________________

_______________________________________________________________________________________

11.HAVE YOU REFERRED THE PATIENT TO ANOTHER PRACTITIONER? YES NO (If “Yes”, please provide the name and address of all applicable physicians or ): ________________________________________________________

____________________________________________________________________________________________________

12.IN YOUR OPINION IS THE PATIENT ABLE TO WORK AT THIS TIME? YES NO

IF “NO”, WHEN DO YOU EXPECT THAT THE PATIENT WILL BE ABLE TO PERFORM SOME WORK?	______/_____/_______
	(Mo) (Day) (Year)

CSEA DI ed 10/2016

MEDICAL PROVIDER’S STATEMENT

PATIENT’S NAME: ______________________________________________ SOCIAL SECURITY NO.: ____________________

(First)

(Middle)

(Last)

13.IS THERE ANY TYPE OF JOB MODIFICATION OR ACCOMODATION THAT WOULD ENABLE THE PATIENT TO WORK

AT THIS TIME? YES NO (If “Yes”, please describe): _______________________________________

____________________________________________________________________________________________________

14.		BASED ON OBJECTIVE FINDINGS AND YOUR
MEDICAL OPINION:
a)	THE PATIENT WAS TOTALLY DISABLED FROM:	_____/_____/_____ THROUGH: _____/_____/_____
		(Mo.) (Day) (Year)	(Mo.) (Day) (Year)
b)	THE PATIENT WAS PARTIALLY DISABLED FROM:	_____/_____/_____ THROUGH: _____/_____/_____
		(Mo.) (Day) (Year)	(Mo.) (Day) (Year)

15.LIST ALL CURRENT RESTRICTIONS AND LIMITATIONS YOU HAVE PLACED ON THE ATIENT’S WORK AND PERSONAL

ACTIVITIES DUE TO HIS OR HER MEDICAL CONDITION (If none, indicate “NONE): ___________________________________

____________________________________________________________________________________________________

16. HAS THE PATIENT BEEN RELEASED FROM YOUR CARE? YES			NO
IF “YES” DATE RELEASED FROM YOUR CARE:		IF “NO”, DATE OF NEXT SCHEDULED TREATMENT OR EVALUATION:
______/_______/________			______/_______/_________
(Mo) (Day)	(Year)		(Mo) (Day)	(Year)

MEDICAL PROVIDER’S DECLARATION AND SIGNATURE

I declare that the answers on this statement are complete and true to the best of my knowledge and belief. I understand that periodic updates (including providing copies of medical records when requested) will be required in the event of a continuing claim.

_______________________________________ _____	__________________		_______________________
PROVIDER’S NAME (PLEASE PRINT)		Specialty	TELEPHONE NUMBER
_________________________________________________	___________________________________________________
STREET ADDRESS	CITY	STATE	ZIP CODE
_____________________________________________		_______________________
PROVIDER’S SIGNATURE		DATE SIGNED
Please return completed forms to:

Pearl Carroll & Associates LLC

12 Cornell Road – Disability Unit

Latham, NY 12110

Fax # 518-640-8105 or email to CustomerCare@PearlCarroll.com

CSEA DI ed 10/2016

Get Pearl Carroll Disability Claim PDF Form

Form Characteristics

Fact Name	Description
Purpose of the Form	The Pearl Carroll Disability Claim form is designed to help members claim disability income benefits while providing necessary details about their condition and recovery.
Required Information	Members must complete all sections of the form, including personal details, nature of the disability, and treatment history, to ensure efficient processing of their claims.
Submission Instructions	The completed claim form must be mailed or emailed to Pearl Carroll & Associates at their Latham, NY, office, specifically to the Disability Claims Unit.
Response Time	Members should expect a delay of 24 to 48 hours before receiving confirmation of receipt for faxes sent to the claims unit.
State-Specific Reference	For New York residents, the claim process is governed by New York law, as outlined in the fraud warning included in the form.
Contact Information	If there are questions about the claim process, members can contact the Office of the Administrator at 1-800-697-2732 for assistance.

Guidelines on Utilizing Pearl Carroll Disability Claim

Filling out the Pearl Carroll Disability Claim form requires attention to detail. Completing this form accurately will help streamline the processing of your claim. Follow the steps outlined below to ensure that you have all necessary information and signatures ready before submission.

Begin with your personal information at the top of the form, including your name, mailing address, and Social Security number.
Indicate the type of disability claim you are filing by checking the appropriate box.
Provide details about your disability. Include the nature of your disability, whether it is work-related, and any details about the injury if applicable.
Document your medical history by listing all providers and hospitals that treated you for the disability, ensuring to include accurate contact information for each.
Request your medical provider to complete both pages of the Medical Provider’s Statement section.
Answer questions regarding your employment details, including your employer's name, address, and the number of hours worked per week.
Detail your daily activities and occupation responsibilities, including the percentage of time spent on each activity. Also, attach a copy of your official job description.
Declare if you are receiving benefits from other sources, such as Workman’s Compensation or Social Security Disability.
Sign and date the Member’s Statement and the Authorization for Release of Information sections to confirm accuracy and give consent for information sharing.
Mail the completed form to Pearl Carroll & Associates LLC at the provided address or submit it via fax or email as specified on the form.

By completing these steps, you will ensure that your claim is submitted correctly and promptly. If any questions arise during the process, consider reaching out to the claims office via the provided contact numbers for assistance.

What You Should Know About This Form

What information do I need to include on the Pearl Carroll Disability Claim form?

It's important to provide detailed information on the form to avoid delays in processing your claim. Complete all sections of the Member Statement, ensuring that you answer every question. You'll need to list all providers and hospitals that treated you for your disability, including their contact details. Additionally, indicate the nature of your disability, whether it is work-related, and supply relevant dates for treatment and your employment status. Ensure both you and your medical provider sign the appropriate sections before submission.

Where should I send the completed Disability Claim form?

Once you have completed the form, return it to Pearl Carroll & Associates LLC at the following address: Disability Claims Unit, 12 Cornell Road, Latham, NY 12110. You can also send it via fax to 518-640-8105 or email it to Customercare@PearlCarroll.com. If you choose to fax the claim, please be advised that confirmation of receipt will not be available for 24 to 48 hours.

What should I do if I recover or return to work?

If you recover from your disability or return to work, you must inform Pearl Carroll & Associates immediately. Complete the statement included in the claim form and send it to the address above or email it at Customercare@PearlCarroll.com. Timely notification is essential to ensure that your benefit payments are adjusted accordingly and to avoid overpayment situations.

Who can I contact if I have questions about my Disability Income benefits claim?

If you have any questions regarding your claim for Disability Income benefits, you can call the Office of the Administrator at 1-800-697-2732. A representative will assist you with your inquiries and provide any necessary clarification concerning the claims process and requirements.

Common mistakes

Filling out the Pearl Carroll Disability Claim form requires careful attention to detail. One common mistake people make is failing to answer all questions in the Member Statement. Complete answers are essential for processing the claim efficiently. Skipping questions can lead to delays or even denials, as incomplete information may raise red flags.

Another frequent error involves the List of Providers and hospitals. Often, individuals do not provide a comprehensive list or forget to include specific providers. Missing information can cause significant delays in claim processing. It’s important to list all healthcare providers who treated the disability, along with their addresses and contact details.

Signing and dating both the Member Statement and the Authorization for Release of Information is crucial. Many people overlook this requirement. Without a signature, the claims department cannot process the request. This oversight can add extra time to an already stressful situation, preventing timely benefits.

Moreover, some claimants neglect to ensure that their Medical Provider completes both pages of the Medical Provider’s Statement. If the form is returned incomplete, it adds another layer of complications. Make sure to communicate with your healthcare provider to guarantee that they fill out and sign the necessary documents.

Another common mistake revolves around failure to notify Pearl Carroll & Associates when returning to work or recovering. Many individuals forget this step, assuming the company will know. However, proactive notification is required. It is important to complete and send the statement back to the claims unit without delay to avoid complications with future benefits.

Finally, failing to provide supporting documents can hinder a claim. For example, if disability is due to a work-related injury or a motor vehicle accident, appropriate documentation, such as the Employee Accident Report or Police Reports, must accompany the claim. Ensure that all necessary documents are attached to prevent issues that could slow down the process.

Documents used along the form

The Pearl Carroll Disability Claim form is a structured document intended to facilitate the submission and processing of disability claims. Several other forms and documents often accompany this claim to ensure that necessary information is gathered completely and accurately. Below is a list of related documents that may be needed with the Pearl Carroll Disability Claim form.

Member Statement: This document requires the claimant to provide personal information and details regarding the nature of the disability. It also includes the claimant’s confirmation of work-related issues and any attempts to return to work.
Medical Provider’s Statement: This statement must be completed by healthcare professionals treating the claimant. It details medical findings and diagnoses and usually requires confirmation of the claimant's treatment history and current medical status.
Authorization for Release of Information: Claimants must complete this form to allow the sharing of their medical records with relevant institutions for their claim evaluation. It is an essential document for gathering medical history relevant to the application.
List of Providers/Hospitals: Claimants need to provide a comprehensive list of all healthcare providers and facilities involved in their treatment. This documentation helps substantiate the claim through a complete medical history.
Employee Accident Report (if applicable): In cases where the disability is work-related, this report, signed by a manager, must be included. It provides details about the incident leading to the injury.

Collectively, these documents help create a comprehensive file for the assessment of the disability claim. It is crucial for claimants to ensure that all required paperwork is accurate and submitted promptly to avoid delays in the claims process.

Similar forms

Social Security Disability Insurance (SSDI) Application: Both the Pearl Carroll Disability Claim form and the SSDI application require detailed information about the applicant’s medical condition, work history, and other relevant personal details. In both cases, accurate and thorough completion is essential for the consideration of benefits.
Workers' Compensation Claims Form: Much like the Pearl Carroll form, a Workers' Compensation form asks for specifics regarding how an injury occurred, related medical treatments, and contact information for healthcare providers. Both forms prioritize the clarity and accuracy of information to expedite claims processing.
Medicare Disability Claim Form: The Medicare Disability Claim form also seeks comprehensive details on an individual's health status and previous treatments. Both forms emphasize the importance of providing complete information to avoid delays in approval.
Veterans Affairs Disability Benefits Application: Like the Pearl Carroll Disability Claim form, the VA form requires a statement of the disability, service history related to the claim, and relevant medical documentation. Both stress the need for complete claims to ensure proper evaluation.
Long-Term Disability Insurance Application: This application, similar to Pearl Carroll's form, requests details about the claimant's inability to work due to health issues, including treatment history and provider information. Clarity in describing the disability is crucial for both forms.
Personal Injury Claim Form: Just as with the Pearl Carroll form, a Personal Injury Claim requires specifics about the injury and the circumstances surrounding it, along with medical evidence supporting the claim. Both forms necessitate precision to validate the claims made.
Short-Term Disability Claim Form: Both the Pearl Carroll form and the Short-Term Disability Claim require applicants to provide detailed medical information, including dates of treatment and recovery as well as any attempts to return to work. Completeness fosters a smoother claims process.

Dos and Don'ts

Complete Every Section: Ensure that all questions in the Member Statement are answered thoroughly. Incomplete forms can delay your claim.
Include Provider Information: Attach a complete list of all providers and hospitals that treated you for your disability. This includes names, addresses, and phone numbers.
Sign and Date: Don’t forget to date and sign both the Member Statement and the Authorization for Release of Information. Missing signatures may result in processing issues.
Medical Provider’s Statement: Make sure your medical provider fills out both pages of their statement. An incomplete Medical Provider's Statement can lead to further delays.

Notify When You Recover: If you recover or return to work, inform Pearl Carroll & Associates right away. This is crucial for managing your claim efficiently.
Avoid Hasty Errors: Take your time filling out the form. Rushing can lead to mistakes that could complicate your claim.
Neglecting Attachments: Don't forget to include any required documents, such as police reports for motor vehicle accidents or hospital discharge papers.
Ignore Contact Information: If you have questions or concerns, don't hesitate to reach out. The contact numbers for assistance are available on the form.

Misconceptions

Misconceptions about the Pearl Carroll Disability Claim Form

Only the Member Needs to Sign: Both the member and the medical provider must sign the form for it to be valid.
Medical Provider’s Statement is Optional: It is essential for your medical provider to complete both pages of their statement.
Submitting a Partial Form is Enough: All questions must be answered. Incomplete forms can delay processing.
Fax Confirmation is Immediate: Confirmations for faxes can take up to 48 hours, so it’s best to follow up if you don’t receive acknowledgment.
Only Major Disabling Injuries Qualify: The form covers various claim types, including non-disabling injuries and survivor benefits.
Returning to Work Negates the Claim: If you return to work in any capacity, you still need to notify Pearl Carroll immediately.
Hospital Discharge Papers are Optional: If treated in a hospital, discharge papers are required to process your claim.
Social Security Benefits Impact Eligibility: Receiving other benefits does not automatically disqualify you from disability income claims.

Key takeaways

Complete all sections of the Member Statement on the Disability Income Claim Form. Incomplete information may lead to delays in processing your claim.
List all medical providers and hospitals that treated you for your disability. Ensure to include their names, addresses, and phone numbers, as missing information can cause claim delays.
Both the Member Statement and the Authorization for Release of Information must be dated and signed. This is a crucial step in validating your claim.
The Medical Provider’s Statement needs to be completed fully. Collaboration with your healthcare provider ensures that your claim reflects all necessary medical information.
If you recover or return to work, inform Pearl Carroll & Associates promptly. Use the provided statement for communication, either by mail or email to ensure they have the most current information.
If you have questions about your Disability Income benefits, do not hesitate to reach out to the Office of the Administrator at 1-800-697-2732 for assistance.

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