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What qualifies an employee for Short Term Disability?

If you answer no to any of the 4 questions below, you will be forwarded to the Certification of Health Care Provider form.

Are you going to be off work for your own medical illness?
Yes No
Have you worked at Deaconess Health System for more than 90 days?
Yes No
Are you authorized to work 40 hours or more a pay period?
Yes No
Will you miss more than 32 hours?
Yes No

You must be at a work computer to fill out the FMLA application online. You will receive your short term disability packet back in your e-mail by filling in the correct e-mail address.

If you have answered yes to all the questions above, you will need to apply for Short term disability. Please go to the FMLA application and apply online.

Forms are available in Human Resources and we can use the Attending Physician’s Statement from UNUM for both STD and FMLA.

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