How to File for Short-Term Disability 

When you’re unable to work due to a non-work related injury, a pregnancy, or recovering from an illness, TeamCare’s Short-Term Disability Benefits are here to take care of you. We provide weekly payments when you’re unable to work, replacing your usual pay with the benefits you’ve paid into. For complete details on your benefits, please refer to My Profile. 

To file for short-term disability and start receiving your weekly payments, follow these steps below. 

Tip: If you work for UPS, there are a few more steps you’ll need to follow. If you’re not a UPS employee, you can skip those steps.

Before You Apply

To be eligible to receive short-term disability benefits, you must be: 

Disabled as a result of a non-work-related injury or illness


Unable to work due to pregnancy


Receiving regular care from your doctor that interrupts your ability to work


Actively employed and covered by the Plan when you become disabled

For members who work for UPS:


Call the Central Office: Any UPS employee going on medical leave is required to call the central office immediately to report their leave. It is your responsibility to contact UPS with this information.


Call The Hartford: After calling the UPS central office, you will need to call The Hartford at 1-866-825-0186 to report your leave. A medical document supporting your leave must be provided. Once you’re on leave, medical documents must be sent to The Hartford every 60 days to recertify your leave — you can upload those documents at


If you work for UPS in New Jersey or New York, you must submit your claim through The Hartford either by calling 1-866-825-0186 to reach a The Hartford representative, or online at


If you work for UPS in California or Rhode Island, you must submit your claim through your state’s short-term disability program. A copy of that claim should then be submitted to TeamCare.


For all other UPS employees, after you call the Central Office and The Hartford, you may proceed with the rest of the Short-Term Disability steps.

For all members:

Download the Form


When you’re ready to apply, you must complete the TeamCare Short-Term Disability Claim Form - Initial Report of Disability. You can download and print the form on the right, or call 1-800-TEAMCARE(1-800-832-6227) to request a claim form be mailed or faxed to you.

Short-Term Disability Claim Form — Initial Report of Disability
Download PDF

Complete the Form

  1. Member Form
    Complete Part 1 yourself.
  2. Doctor Form
    Give the form to your treating physician to complete Part 2.

    Keep in mind that most providers will require you to come into their office for a visit to diagnose your disability, and some may charge an additional fee to complete the form. Contact your provider for their policy on completing disability forms.

  3. Employer Form

    Give the form with Parts 1 and 2 to your employer.

    Once Parts 1 and 2 are complete, your employer will complete Part 3.

Submit the Form

Once the TeamCare Short-Term Disability Claim Form - Initial Report of Disability is completed, submit the form to TeamCare. You can submit the form one of three ways, outlined below. For the fastest turnaround time, we recommend scanning your completed form and sending to TeamCare via your Message Center.
  • Message Center

    Scan your completed form. Once logged in, Navigate to the Message Center, compose your message, attach your scanned form, and send. You’ll receive confirmation once it has been received. Easy! 

    Message Center
  • Mail

    We recommend making a copy of your form for your records. Mail the original to the following address:
    Central States Health Fund
    PO Box 5107
    Des Plaines, Illinois 60017-5107
  • Fax

    Fax your completed form to TeamCare directly at 1-847-518-9757. 

After we receive your form, we’ll send you a confirmation message via the same channel through which you submitted it. For instance, if you’ve mailed your form, watch the mail for a letter from us confirming receipt. If you have not received confirmation within five business days, please contact a Benefits Specialist via your Message Center or by calling us at 1-800-TEAMCARE (1-800-832-6227).

Continuation Forms

After your disability payments begin, you may be asked to submit a Short-Term Disability - Continuation Form to TeamCare with updates from your physician. Complete and submit the Short-Term Disability - Continuation Form by following the same steps above. To avoid any delays in processing your payments, please submit forms as soon as possible.

If you have questions, please send a secure message through the Message Center or call a Benefits Specialist at 1-800-TEAMCARE (1-800-832-6227).

From all of us at TeamCare,
feel better soon!