Form G-28203 - Feb 2019

Form G-28203 is used by policyholders to claim disability benefits. It requires the policyholder's personal, employer, and medical information. Once completed, the form should be submitted to OneAmerica Disability Claims.

Multiple parties are involved in completing this form, including the employee, policyholder and attending physician.

The completed Form G-28203 should be submitted to the OneAmerica Disability Claims, PO Box 7106, Indianapolis, IN 46207-7106.