Disability and Life Insurance Options

Short Term Disability

Dearborn National 

Summary Short Term Disability Information 
Certificate Book 
Claim Form

Long Term Disability


Summary Long Term Disability Information  
Certificate Book  
Claim Form

Life Insurance

Minnesota Life

Summary Employee Life Insurance Information  
Certificate Book 
    A.  Class 1 Details

    B.  Class 2 Details

    C.  Class 3 Details

    D.  Class 4 Details

    E.  Class 5 Details

Beneficiary Election 
The Beneficiary Election Form can be returned to Human Resources Benefits Administration, +0602.

Workers' Compensation / Work Related Injury Forms

Please use these forms if you should sustain a work related injury. Completion of these forms does not assure the allowance of the claim in accordance with the Ohio Bureau of Workers Compensation.