Short Term Disability Form Template for Nigeria

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Key Requirements PROMPT example:

Short Term Disability Form

"I need a Short Term Disability Form for our manufacturing company in Lagos, Nigeria, that includes specific provisions for physical injuries and graduated return-to-work protocols, compliant with the latest Nigerian disability regulations as of January 2025."

Document background

The Short Term Disability Form is a crucial document used in the Nigerian employment context when an employee needs to claim benefits due to a temporary inability to work. This form, designed in accordance with Nigerian labor laws and disability regulations, serves as the primary mechanism for initiating and processing short-term disability claims. It captures essential information including the nature of disability, medical certification, employment details, and benefit calculations. The document is particularly important given Nigeria's legal framework under the Discrimination Against Persons with Disabilities (Prohibition) Act 2018 and the Employees Compensation Act 2010, which mandate proper documentation and fair treatment of disability claims. The form ensures compliance with legal requirements while facilitating efficient processing of disability benefits.

Suggested Sections

1. Employee Information: Basic personal details including name, employee ID, contact information, and social security/national ID numbers

2. Employment Details: Current job title, department, date of hire, and regular work schedule

3. Disability Information: Nature of disability, date of onset, expected duration, and whether condition is work-related

4. Medical Information: Description of medical condition, symptoms, and treatment plan

5. Healthcare Provider Certification: Section for licensed medical practitioner to verify disability, including their contact information and license details

6. Employer Certification: Verification of employment status and job details by authorized employer representative

7. Employee Declaration: Employee's certification of truth of information and authorization for release of medical information

Optional Sections

1. Additional Income Sources: Section to declare other income sources or benefits being received, used when employee has multiple income streams

2. Return to Work Plan: Details of graduated return to work schedule, used when a phased return is anticipated

3. Accident Details: Specific information about accident if disability is accident-related

4. Third Party Claims: Information about any third-party claims related to the disability, used when disability resulted from third-party actions

Suggested Schedules

1. Medical Records Authorization Form: Standard form for authorizing release of medical records from healthcare providers

2. Employer's Salary Verification: Detailed breakdown of employee's salary and benefits for benefit calculation

3. Job Description: Detailed description of employee's regular job duties and physical requirements

4. Physician's Supplementary Report: Additional medical information form for complex cases

Authors

Alex Denne

Head of Growth (Open Source Law) @ Genie AI | 3 x UCL-Certified in Contract Law & Drafting | 4+ Years Managing 1M+ Legal Documents | Serial Founder & Legal AI Author

alex.den.21@genieai.co

Relevant legal definitions

Clauses

Relevant Industries

Healthcare

Manufacturing

Financial Services

Technology

Construction

Education

Retail

Oil and Gas

Transportation

Public Sector

Mining

Agriculture

Telecommunications

Professional Services

Relevant Teams

Human Resources

Benefits Administration

Payroll

Legal

Compliance

Risk Management

Occupational Health

Employee Relations

Relevant Roles

Human Resources Manager

Benefits Administrator

Compensation Specialist

HR Director

Personnel Manager

Occupational Health Manager

Risk Management Officer

Compliance Officer

Employee Relations Manager

HR Business Partner

Payroll Manager

Claims Processing Specialist

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Let's create your Short Term Disability Form

Authors

Alex Denne

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