If you are not enrolled in STD, a completed Disability claim form is required. All claim forms require information to be provided by three parties: the employee, the employer and your physician. You must complete your portion of the claim form and return it to Dearborn National along with the completed physician's portion. Contact your institution Benefits Office and request them to complete the Employer's portion and send it directly to Dearborn National at the address reflected on the form. Your claim for LTD must be received by FDL within 12 months of the date LTD benefits would become payable.