File a Disability Claim

Please note: On Wednesday, November 25th, our office is closing at 3 PM CST. We will remain closed for Thanksgiving, Thursday, November 26th and Friday November 27th.

You can choose to file your entire claim over the phone by calling the Cornerstone Claims Department at 847-387-3889, or you can complete the below form and schedule a time to finish the claim filing process.

1 Contact Information

2 Employer Information

3 Claim Information

4 Availability

Name*
First Last
Address*
Street Address Address Line 2 City State ZIP
Primary Phone*
Phone Type*
Email
Date of Birth*
MM
DD
YYYY

Union*
Division*
Employer*
Job Title*
Date of Hire*
MM
DD
YYYY

Last Day Worked*
MM
DD
YYYY
Date of Disability*
MM
DD
YYYY
Medical Condition*
Estimated Time Off*
Doctor's Name*
First Last
Doctor's Phone*
Doctor's Fax
Did your condition occur:*
Is your condition due to an:*

Select a date/time to be contacted by a Cornerstone Claims Advocate to finish filing your claim

Our business hours are Monday-Friday from 8:00am-5:00pm
Date*
MM
DD
YYYY
Time*

: HH

MM
Your Time Zone*

Share This