If your treating physician indicates you will be out of work more than your benefit waiting period due to disability, you may file for benefits under the Duke Disability plan. Please submit the form below to request a disability claim kit.

Return the claim paperwork to Human Resources within 180 days of your becoming disabled and/or your last day worked due to disability. Your claim will be sent to the disability vendor, who will acknowledge receipt and notify you if additional medical information is needed. Approval or denial of a disability claim, which generally takes four to six weeks, will be determined after all the necessary documentation is obtained for claim review. Please note that applying for Disability does not guarantee that you will be approved.

Note: Eligibility to file a Duke disability claim will be verified before a claim kit is sent.

First Name:	Last Name:
Email:
Daytime Phone:	Date of Birth:
Mailing Address:	City:	State:	Zip Code:
Hire Date:	Duke Unique ID:
Last Day Worked Due to Disability:
Where do you work?	Duke University Duke University Health System Durham Regional Hospital Duke Raleigh Hospital
Are you a PDC member?	Yes No
Comments: