The Aetna short-term disability claim form is a two-sided document that you, your employer, and your treating doctor each complete in parts: you fill in your personal and job information, your employer confirms your coverage and income, and your physician completes the Attending Physician’s Statement on the reverse. Once every section is filled in, your employer forwards the packet to Aetna for review. Because most employer-sponsored disability plans are governed by the federal Employee Retirement Income Security Act (ERISA), the deadlines and appeal rights attached to the form come from federal regulation, not just Aetna’s internal rules.
Where to Get the Form and When to Start It
The fastest way to pull the form is through the Aetna WorkAbility website, which covered employees can reach any time to download claim documents and check existing claims. Many employers also post it on an internal HR portal. If neither route works, call Aetna Voluntary Plans at 1-866-292-3374 and request a paper copy by mail.
Don’t fill it out on your first day away from work. The form’s own instructions say to complete it once your absence has stretched past your plan’s waiting period, sometimes called the elimination period. That window usually runs between 1 and 14 calendar days depending on your employer’s plan, and you have to be continuously unable to work through it for benefits to begin. Use the waiting period to gather paperwork so you can submit as soon as you’re eligible.
What to Gather Before You Start
Having a few items in front of you keeps the form moving:
- Your Social Security number and the Aetna control or group number, which appears on your benefits ID card or enrollment paperwork.
- Your employer’s legal name, address, and ZIP code, plus your supervisor’s name and phone number in case Aetna needs clarification.
- Your basic weekly or monthly earnings before the disability began. Your employer confirms this on the form, but knowing your own figures lets you catch errors.
- The name, address, and phone number of every doctor involved in your care, including specialists.
- Your medical timeline: when symptoms first appeared or the accident occurred, the date you stopped working, and dates of treatment. Mismatches between what you write and what your medical records show are one of the fastest routes to a delay.
You don’t need to supply ICD-10 diagnosis codes yourself; your doctor handles those on the physician’s statement. If you already have a code from a recent visit summary, keep it nearby so you can check the form for consistency before it goes out.
Know How Your Plan Defines Disability
Short-term disability plans generally apply an “own occupation” standard: Aetna evaluates whether your condition prevents you from doing the specific duties of your actual job, not whether you could perform some other job. That makes the way you describe your work on the form unusually important. A broken wrist means something different for a desk worker than for someone operating heavy machinery. Be specific about what your job physically requires: lifting limits, hours on your feet, repetitive hand motions, driving, supervising others.
Filling Out the Form Section by Section
The front of the form carries numbered sections that you and your employer complete. The back is the Attending Physician’s Statement, which your doctor fills in.
Section 1: Employer Information
Your employer enters the company name, Aetna control number, company address, and your basic income. This section establishes that you’re covered under the group policy and sets the baseline Aetna uses to calculate your weekly benefit. If your workplace has an HR or benefits coordinator, they typically handle it. Confirm the section is complete before submission; a blank employer section is an easy reason for Aetna to send the form back.
Section 2: Employee Information
You fill in your Social Security number, full name, date of birth, address, and daytime phone number. The form also asks whether your employment has ended or you’re on layoff, because coverage typically ends with employment. There’s a field for your basic income and one for your job duties. The job-duties field is where many claimants underperform. Don’t write “office work” and move on. Spell out the physical and cognitive demands of the role, because Aetna compares your doctor’s listed restrictions against this description to decide whether you qualify.
Section 3: Claim Information
This section asks three threshold questions: Is your absence work-related? Did it result from an accident? What is the nature of the illness or injury? Short-term disability covers non-occupational conditions only. If your injury happened on the job, workers’ compensation is the right program, not STD. Describe the condition in plain language, and if it stemmed from an accident, explain how, when, and where. Enter your expected return-to-work date if your doctor has given you one.
Section 4: Authorization and Release
Signing here gives Aetna permission to obtain medical records from your doctors, hospitals, and other providers involved in your treatment. The release also covers independent claim administrators and utilization review organizations Aetna contracts with. The authorization is broad by design, because Aetna needs your full clinical picture to evaluate the claim. You can request a copy of the signed authorization, and a photocopy carries the same legal weight as the original.
Section 5: Misrepresentation
A brief acknowledgment that knowingly providing false information can lead to denial or termination of benefits and potential legal consequences. Read it, then sign.
The Attending Physician’s Statement (Reverse Side)
Your doctor completes the entire reverse side. It’s the medical backbone of your claim and runs to ten areas covering history, diagnosis, treatment, limitations, and prognosis. The fields that matter most to the outcome are:
- History: when symptoms first appeared, whether you’ve had the same condition before, and whether it arose from employment.
- Diagnosis: the ICD diagnostic code (mandatory), a written diagnosis with any complications, your subjective symptoms, and objective findings such as lab results, imaging, and exam notes.
- Treatment: dates of first and last visits, visit frequency, medications prescribed, and any surgical procedures with dates.
- Limitations and restrictions: what you can currently do, what you cannot, and the restrictions the doctor has placed on your activity. This is the section Aetna weighs most heavily against your job-duties description.
- Physical impairment classification on a five-class scale, running from no functional limitation to severe limitation incapable of even sedentary activity.
- Prognosis: whether recovery is considered guarded, good, fair, or poor; the estimated date of maximum medical improvement; and the expected return-to-work date.
Specialized sub-fields apply where relevant: an expected delivery date for pregnancy, functional capacity classification and blood pressure for cardiac conditions, and additional detail for mental health or nervous system conditions, including whether you are competent to endorse checks and manage benefit proceeds.
Claims most often stumble on this page. Vague entries like “patient cannot work” with no supporting clinical findings give reviewers little to approve. Ask your doctor to attach lab results, imaging reports, or operative notes rather than squeezing everything into the limited space on the form.
Where to Send the Completed Form
Once you and your physician have each completed your sections, the instructions direct you to return the form to your employer. Your employer adds Section 1 if it isn’t already done and forwards the packet to Aetna. For Aetna Voluntary Plans, the submission options are:
- Mail: Aetna Voluntary Plans, PO Box 14079, Lexington, KY 40512-4079
- Fax: 1-859-455-8650
If your employer handles the mailing, confirm the send date. If you’re submitting directly because your employer tells you to, fax is faster than mail and produces a transmission confirmation. For mailed submissions, use certified mail with return receipt so you have proof of the date Aetna received the claim. That date starts the federal clock on their decision.
What Happens After You File
A claims examiner reviews your file against your plan’s definition of disability. Under ERISA, Aetna has 45 days from receipt of the claim to make an initial decision. The company can extend that window by up to 30 days if circumstances beyond its control require it, as long as it notifies you before the original 45 days run out and explains what remains unresolved. A second 30-day extension is permitted under the same notice rules, for a possible total of 105 days. If Aetna asks you for additional information during an extension, the decision clock pauses from the request date until you respond, and you get at least 45 days to supply what’s needed.
If the claim is approved, Aetna calculates your weekly benefit from the income figure your employer confirmed and the percentage your plan specifies. That percentage varies by plan: some pay 50% of pre-disability earnings, others pay 60% or 66⅔%. Check your benefits summary for the exact figure. Payments typically begin after the elimination period ends, not retroactively to your first day out.
You can track status, see outstanding documents, and watch for a posted decision through the Aetna WorkAbility website.
If Your Claim Is Denied
Aetna has to send you a written denial notice that meets specific federal content requirements. For disability claims, the notice must list the specific reasons for denial, cite the plan provisions it relied on, describe any additional information that could change the outcome, and explain the plan’s appeal process. The notice must also address why Aetna disagreed with the medical opinions of your treating physicians and describe any internal guidelines or protocols applied. If the denial rested on a medical necessity or experimental-treatment exclusion, Aetna must either explain the clinical reasoning or offer that explanation free of charge on request.
You have 180 days from receiving the denial to file an appeal. On appeal, Aetna has to review the claim fresh using a different reviewer, you can submit new evidence, and you have the right to free access to your entire claim file, including the medical opinions Aetna relied on.
Common reasons for initial denials include insufficient medical documentation (the physician’s statement lacked objective findings), inconsistencies between the form and the medical records, missed deadlines for filing or responding to information requests, and pre-existing condition exclusions. That last one catches people off guard. Many plans exclude conditions diagnosed or treated within a lookback window before coverage began, often 3 to 12 months. Check your plan summary for the specific period.
Three Things the Form Doesn’t Do
Short-term disability pays a portion of your income; it does not by itself protect your job. The Family and Medical Leave Act does. If you qualify for FMLA (generally 12 months of employment and 1,250 hours worked at a covered employer), your employer can run FMLA concurrently with your STD absence, meaning your 12 weeks of job-protected leave ticks down while you collect disability payments rather than afterward.
If you work in California, Hawaii, New Jersey, New York, or Rhode Island, your state runs its own mandatory short-term disability program funded by employee payroll contributions. Aetna’s coverage and a state program can overlap, but most plans coordinate benefits so you don’t collect more than your pre-disability income. Ask your HR department how the two interact for your plan.
Whether your STD benefits are taxable depends on who paid the insurance premiums. If your employer paid the full premium, your benefits are taxable as ordinary income, and Aetna will withhold taxes or issue a W-2. If you paid the full premium yourself with after-tax payroll deductions, the benefits are not taxable. When the cost is split, only the portion tied to your employer’s premium contribution is taxable.