State Disability Program
The purpose is to provide income replacement and insurance premium continuation for state employees who are unable to work due to illness or non-occupational injury. The program includes both Short-Term Disability (STD) benefits and Long-Term Disability (LTD) benefits. The Disability Program is provided to employees as a bridge to sustain employees financially either to a full recovery, partial recovery or permanent disability through Social Security.
Information about submitting a claim and the state’s Short and Long Term Disability Plan can be found in the following links:
- Short and Long Term Disability & Worker's Compensation Programs - Employee Handbook
- Instructions for submission of a disability claim
Disability Forms
If there is a chance that a leave for the employee's own serious health condition may last more than 30 consecutive calendar days, then the employee should apply for the state's Short/Long Term Disability (S/LTD) Plan by completing and submitting these forms to the address/fax listed on the forms as soon as the need for leave becomes known. This is a separate process and must be completed in addition to the FML process in appropriate situations.
Employee completes these forms:
Important Note: Employee forms may be completed electronically at https://www.jwfspecialty.com/applications-forms by clicking the “State of Indiana Employee’s Disability Application” link. Paper applications will also be accepted unsigned or with an e-signature.
- Employee's Statement of Claim
- Employee's Authorization for Release of Medical Information
- Options Statement
Doctor completes this form:
HR staff assigned to your agency complete this form:
State Worker’s Compensation Program
The state provides a Worker's Compensation Program for all employees, as required by Indiana Code 22-3-1-1 through 22-3-12-5. The purpose of the Worker's Compensation Program is to provide the statutory benefits afforded an employee that is injured in the course and scope of his or her employment. The state takes seriously the responsibility of providing high quality medical care with the goal of a full recovery and return to work.