File a Disability Claim

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.

1Contact Information

2Employer Information

3Claim Information

4Availability

Name*
First Last
Address*
Street Address Address Line 2 City State ZIP
Primary Phone*
Phone Type*
Email
Date of Birth*
Month
Day
Year

Union*
Division*
Employer*
Job Title*
Date of Hire*
Month
Day
Year

Last Day Worked*
Month
Day
Year
Date of Disability*
Month
Day
Year
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*
Month
Day
Year
Time*

: Hours

Minutes
Your Time Zone*