Short-term Disability

Short Term Disability Benefits Request (Form 701) Purpose: Use this form to request short-term benefits through the Disability Income Plan of North Carolina. Email Contact: benefits@charlotte.edu Last Updated: August 14, 2024

Short Term Disability Benefits Earnings and Medical Eligibility Report (Form 703) Purpose: Use this form to report monthly certification from the medical provider for short term disability benefits. Email Contact: benefits@charlotte.edu Last Updated: August 14, 2024

Short Term Disability – Medical Report for Eligibility Review (Form 7A) Purpose: Use this form to request medical eligibility for short-term disability coverage under the Disability Income Plan of North Carolina. Email Contact: benefits@charlotte.edu Last Updated: August 14, 2024