Physicians Statement of Disability
Instructions
In order to evaluate your disability claim, it is important that we obtain information regarding your disabling diagnosis and functional abilities. Please follow the instructions below:
1. Print the Physicians Statement of Disability below:
 (PDF)
2. Have your physician complete and sign the form. Along with the completed form, please have your physician provide any medical documentation, such as office notes and test results, that may not already be on file.
3. Mail or fax the completed form and medical documentation to the office that handles your claim:
Dallas, TX
CIGNA Group Insurance
P.O. Box 709015
Dallas, TX 75370-9015
Fax 866.517.9871
Glendale, CA
CIGNA Group Insurance
400 N. Brand Blvd., Suite 400
Glendale, CA 91203
Fax 866.517.9873
Pittsburgh, PA
CIGNA Group Insurance
P.O. Box 22325
Pittsburgh, PA 15219
Fax 866.517.9874
Eden Prairie, MN
CIGNA Group Insurance
P.O. Box 46257
Eden Prairie, MN 55244-3057
Fax 866.960.7550
If you are unsure which office handles your claim, please contact a Customer Service Representative at 1.800.36CIGNA or 1.800.362.4462
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