FMLA & DISABILITY
FORM REQUESTS
Submit your form completion requests online through HealthMark’s Request Manager™.
https://requestmanager.healthmark-group.com/register
FORM FEES
1st form fee - $35
Additional forms fee - $35
Form updates - $10
* Forms that exceed four pages may incur additional fees
* You will be notified of all fees prior to the release of forms, and forms are released only after payment
* Initial statuses are available 48 hours after submission
* Paper forms submissions will be more expensive - $40
GET STARTED
https://requestmanager.healthmark-group.com/register
Questions?
Email: FMLA@HEALTHMARK-GROUP.COM
Phone: (972)895-2138
Hours: Monday - Friday 6a-3p PST
Status updates are sent via email and you will be notified once your forms are ready for download. Each FMLA / disability form completion request requires a minimal fee.
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How Do I File a New Disability Claim Online?
Disability Insurance claims may be filed online using SDI Online
https://www.edd.ca.gov/Disability/SDI_Online.htm
To use SDI Online, you must first complete a one-time registration with BenefitPrograms Online
https://edd.ca.gov/Benefit_Programs_Online.htm
SDI Online provides claimants, physicians/practitioners, and employers with electronic and automated options that are simple to use and available 24 hours a day, 7 days a week.
To order a paper Claim for Disability Insurance (DI) Benefits (DE 2501) and file by mail, visit Online Forms and Publications https://www.edd.ca.gov/Forms/
or call 1-800-480-3287 (English), 1-866-658-8846 (en español), or TTY 1-800-563-2441.
How Do I File a New Disability Claim on Paper?
Disability Insurance claims may be filed on paper, through our office. You will pay the $40 filing
fee and pick up the red SDI form at the front office to fill out by hand. It is less expensive to file online and work with Healthmark.
How Do I Submit my FMLA, Accommodation or any other work forms?
If you already have your forms in hand, you can give them to the front desk and they will forward them to Healthmark.
If your Employer is requesting a fax number, they can fax the forms to Healthmark directly (888) 882-5021.
If you have an electronic copy of your forms, you can visit
https://requestmanager.healthmark-group.com
No matter how you submit your forms, you will still need to initiate the request through Healthmark.
https://requestmanager.healthmark-group.com
If you have any questions, you can reach out to Healthmark at (972) 895-2138 or email at fmla@healthmark-group.com. To check the status of an existing request please email status@healthmark-group.com.
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MEDICAL RECORDS
REQUESTS
Submit your form completion requests online through HealthMark’s Request Manager™.
https://requestmanager.healthmark-group.com/register
There is no fee to request your own medical records
