Broadspire FMLA Forms

Call Broadspire at 877-222-8705 to apply for a leave of absence, workplace accommodation or short term disability claim and follow instructions given during the call. Broadspire will work with you to determine the type of leave that best fits your situation: Intermittent is leave taken in intermittent periods of time (minutes, hours or a whole day) rather than in consecutive days. …

The completed forms should be returned to your employer so they can submit them to Broadspire. Enclosed are the following forms: 1. Long Term Disability Employee Claim Statement 2. Medical and Sensitive information Release Form 3. Third party Authorization Form (if applicable) 4. W-4 IRS Tax Form 5. A-4 State of Arizona Tax Form 6.

BASIC – FMLA – Forms

Broadspire provides customized, integrated claims solutions to clients across the globe. Through our industry-leading expertise, innovative technology and unrelenting focus on continuous improvement, we implement programs that result in lower costs, faster recovery times, and greater satisfaction for everyone involved.

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Employer Instructions and Forms When you become aware of an employee’s need for family or medical leave* complete the following: Provide the employee with a Request for Family/Medical Leave under the FMLA form. Have the employee complete the form and return it to their supervisor or other designated company representative for approval or denial of leave. After the completed …

Whether for short or long term disability, FMLA, IDM – or anything in between – Crawford, through its global TPA and medical management provider, Broadspire, acts as the guardian of your program’s financial health. This, coupled with our intense focus on customer service and satisfaction, allows you to step away from the program and trust that employees, claimants, and …

Welcome to Broadspire … 888 -599 8572, to open a disability or FMLA claim. There is someone available to take your call 24/7, 365 days a year. If you already have paperwork, you may also send your paperwork to: Fax number: 1-859-550-2744 or E-Fax –770-723-8746. You may also mail your paperwork to: Broadspire Disability & Leave Management PO BOX 14773, Lexington, KY 40512 …