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Resource Center for Physicians
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Prudential Group Insurance welcomes participating physicians to our special online resource center, a website created specifically for physicians who work with Prudential on disability claims.
The resource center can help make it easier for you to supply the medical information needed to process claims. In addition, the center serves as a repository for news and information about changes in rules and regulations related to disability and family medical leave.
Here you will find the forms that you can use to submit claims information. The site will also provide special alerts from time to time, notifying you of changes in processes and procedures that affect disability claims management here at Prudential.
Forms
- Attending Physician's Statement PDF opens in new window
- Attending Physician Statement Cancer PDF opens in new window
- Attending Physician Statement Cardiac PDF opens in new window
- Attending Physician's Statement (Spanish) PDF opens in new window
- Attending Physician's Behavioral Health Statement PDF opens in new window
- Attending Physician's Statement and Certification of Health Care Provider for Employee's Serious Health Condition PDF opens in new window
- Certification of Health Care Provider for Employee Serious Health Condition PDF opens in new window
- Certification of Health Care Provider for Family Member's Serious Health Condition PDF opens in new window
- Behavioral Health Capacity Questionnaire PDF opens in new window
- Capacity Questionnaire PDF opens in new window
- Kurtzke Functional Systems Scores (FSS) PDF opens in new window
- Mental Status Examination PDF opens in new window
- Neurological Assessment of MS Diagnosis PDF opens in new window
- Psychiatric Work Readiness Assessment PDF opens in new window
- Supplemental Attending Physician’s Statement PDF opens in new window
- Visual Capacity Questionnaire PDF opens in new window
For Compliance only California COA #1179 NAIC Code #68241