Disability Insurance Claim Log PDF (Free)

Private disability insurers often ask for repeated paperwork. A claim log helps you prove what you sent, track benefit status changes, and build a record for ERISA or bad faith claims. Use this free PDF template to keep everything organized.

When to use this

• You opened a short-term or long-term disability claim with a private insurer.
• The insurer keeps asking for more medical records or forms.
• You’re preparing for a potential appeal or litigation and need a clear history of delays or denials.

How to do it (fast)

1. Enter your insured information, claim number, and insurer name.
2. Log each interaction with dates, contact method, and who you spoke with.
3. Record documents requested or sent, and note the benefit status (pending, paid, denied, terminated).
4. Add the insurer’s stated reason for delays or decisions so you can challenge inconsistencies.
5. Download the PDF and share it with your doctor, attorney, or HR contact as needed.

Why this helps

• Creates a single record you can hand to an attorney for ERISA or bad faith review.
• Shows patterns of repeated requests or unexplained status changes.
• Keeps medical evidence and correspondence aligned with benefit decisions.

Related tools

• Disability Insurance Claim Log Tool
• SSDI Appeal Evidence Log
• Medical Evidence Chronology
• Identity Theft / Fraud Log

Not legal advice. Courts set their own rules. Keep your original records.