The City of Fairfield is self-insured for a Short-Term Disability (STD) Benefit Plan. Eligible City employees may apply to use this benefit in the event of a non-work-related injury or illness, including pregnancy, for which you are unable to work.

When the need for STD leave is foreseeable, the employee must give the City at least 30 days advance notice of the need to take leave. In rare circumstances if 30 days’ notice is not possible, the employee is required to provide notice “as soon as practicable”. After you have notified your Supervisor and HR, contact Prudential by phone (recommended) to file your claim:

Group Disability Insurance

The Prudential Insurance Company of America Disability Management Services
P.O. Box 13480, Philadelphia, PA 19176
Tel: 800-842-1718  Fax: 877-889-4885

Apply Online

http://www.prudential.com/mybenefits

Employer number: P13363

For more information regarding STD, please see the documents below:

• Short-Term Disability - Summary of Benefits: Outlines the City's STD plan
• Prudential Disability Brochure: Explains how to apply and what info to have ready

Required Forms:

• Physician Statement
• Release of Information to Prudential
• Employee Claim Form