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Outline

The Sedgwick Direct Deposit form serves as a crucial document for employees under the Arizona State Retirement System (ASRS) who are eligible for long-term disability benefits. Essentially, it is a vehicle through which these beneficiaries give Sedgwick, in conjunction with their employer, the authorization to deposit disability benefit payments directly into their bank accounts. The form is straightforward yet comprehensive, requiring personal information, employer details, and precise banking coordinates from the employee. Its main sections outline the process for initiating, changing, or canceling the direct deposit of benefit payments. The form not only underscores the convenience of electronic funds transfers but also introduces layers of security and efficiency into the handling of disability benefits. Moreover, it highlights the conditions under which Sedgwick and the employer can correct overpayments by adjusting electronic transfers, mitigating the risk of financial errors. The responsibility it places on employees to report changes or cancellations in a timely manner, thereby allowing Sedgwick reasonable time to process these requests, is also noteworthy. Additionally, it clarifies that any costs or service charges arising from electronic fund transfer errors are not the employer's or Sedgwick's liability. Completing and submitting this form, whether via fax or mail, is the first step for ASRS employees in streamlining their benefit payments, marking an essential administrative task for securing their financial stability during challenging times.

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ASRS Long Term Disability

Direct Deposit Authorization Form

PART 1: To be Completed by Employee

Employer:

ARIZONA STATE RETIREMENT SYSTEM

Employee:

First Name _____________________Middle Initial_______ Last Name___________________________

SSN:

______________________________

Agreement

I authorize Sedgwick and my Employer, at their discretion, to deposit my approved disability benefit payments into my account as indicated below.

This authorization will remain in effect until I give written notice to Sedgwick either to change or cancel this authorization, in such time and in such manner as to afford Sedgwick a reasonable opportunity to act on it. I understand that my deposit will not be posted to my account until the date of my monthly benefit payment.

I have provided Sedgwick with my financial institution information solely for the purpose of verifying my account number and transit/routing information.

I grant Sedgwick and my Employer the right to correct any Electronic Funds Transfer resulting from erroneous overpayment by debiting my accounts to the extent of such overpayment. I further understand that Sedgwick or my Employer is not responsible for any costs or service charges incurred by me as a result of Sedgwicks actions related to Electronic Funds Transfer.

Action Requested

Please establish a NEW direct deposit to the bank and account listed below.

Please CHANGE my direct deposit, and direct my benefit payments to the bank and account listed below.

Please CANCEL the direct deposit of my benefit payments to the bank and account listed below and send my benefit payment check to me in the mail.

Employee SignatureDate

PART 2: Financial Institution Information

Name of Financial Institution:

Routing #:

 

 

 

 

 

 

 

 

 

 

 

 

Telephone #: (

 

 

 

)

 

 

 

-

 

 

 

 

Account #:

 

 

 

 

 

 

 

 

 

 

 

 

Type of Account:

 

 

Checking

 

Savings

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

After completing this form, please fax it to Sedgwick at (855) 800-5116 or mail it to Sedgwick, PO Box 14648, Lexington, KY 40512. Sedgwick only needs one copy of this form, so please choose one method of delivery only.

For Sedgwick Use Only

Prenote Completed By: ___________________________________________________ Date: ________________________

Sedgwick Direct Deposit Form 2015

Document Attributes

Fact Name Description
Form Purpose This form is used to authorize Sedgwick and the Arizona State Retirement System to directly deposit approved long-term disability benefit payments into the employee's bank account.
Parties Involved The form involves Sedgwick, the Arizona State Retirement System (employer), and the employee receiving disability benefits.
Authorization Continuity The authorization will remain active until the employee provides written notice to Sedgwick to change or cancel it, allowing reasonable time for Sedgwick to act on the notice.
Payment Posting Deposits will not be posted to the employee's account until the date of their monthly benefit payment.
Financial Information Usage Employee's financial institution information is provided to Sedgwick solely for verifying account number and transit/routing information.
Right to Correct Overpayments Sedgwick and the employer have the right to correct any overpayments by debiting the employee's account to the extent of such overpayment.
Responsibility for Costs Sedgwick or the employer is not responsible for any costs or service charges incurred by the employee as a result of actions related to Electronic Funds Transfer.
Action Options Employees can request to establish a new direct deposit, change an existing direct deposit, or cancel direct deposit and receive checks via mail.
Delivery Methods Completed forms can be faxed to Sedgwick at (855) 800-5116 or mailed to their PO Box in Lexington, KY. Only one copy of the form should be sent through one of these methods.

How to Fill Out Sedgwick Direct Deposit

Filling out the Sedgwick Direct Deposit Authorization Form is a crucial step for individuals who are eligible to receive long-term disability benefit payments from the Arizona State Retirement System. This process allows for the swift and secure transfer of funds directly into a bank account of one's choosing, eliminating the wait and potential risk involved with receiving paper checks. Direct deposit ensures that benefit payments are deposited on a consistent basis into the account specified by the beneficiary. To achieve this, the form must be filled out correctly and submitted to Sedgwick. Here are the step-by-step instructions.

  1. Begin by entering your first name, middle initial, and last name in the fields provided under "Employee".
  2. Input your Social Security Number (SSN) in the designated space.
  3. Select the action you are requesting by checking the appropriate box: to establish a new direct deposit, change an existing direct deposit, or cancel direct deposit and instead receive benefit payments by mail.
  4. Sign your name and write the date in the "Employee Signature" and "Date" fields, respectively, to confirm your authorization for Sedgwick and your employer to deposit your disability benefit payments as described.
  5. Under "PART 2: Financial Institution Information", provide the name of your financial institution where the direct deposits will be made.
  6. Enter the routing number of your financial institution. This is typically a nine-digit number found on the bottom left of your checks.
  7. Supply the telephone number of your bank or financial institution, including the area code.
  8. Insert your account number in the space provided. Make sure to double-check this number for accuracy to ensure the timely deposit of your funds.
  9. Indicate the type of account where your benefits will be deposited by selecting either "Checking" or "Savings".
  10. Once the form is completely filled out, decide on a method of delivery. You can either fax the form to Sedgwick at (855) 800-5116 or mail it to Sedgwick, PO Box 14648, Lexington, KY 40512. Select only one method to avoid duplication.

After submission, Sedgwick will process your direct deposit request, which includes a verification step known as a "prenote" to ensure that the account information is correct before depositing your benefits. This setup or any requested changes to your direct deposit can take some time to become effective. It is important to monitor your account around the time of your usual benefit payment to confirm the deposit has been made as intended. If you encounter any issues or do not see the deposit, contacting Sedgwick directly is advisable for resolution.

More About Sedgwick Direct Deposit

  1. How do I set up direct deposit for my disability benefits with Sedgwick?

    To set up direct deposit for your disability benefits, you need to complete the Sedgwick Direct Deposit Authorization Form. Fill out Part 1 with your personal and employer information, including your full name, Social Security Number (SSN), and the name of your employer, which is the Arizona State Retirement System (ASRS) in this case. Indicate whether you are establishing a new direct deposit, changing an existing one, or canceling it. Provide your bank information in Part 2, specifying the name of your financial institution, the routing number, your account number, and whether it's a checking or savings account. Finally, sign and date the form. You can then fax it to (855) 800-5116 or mail it to Sedgwick, PO Box 14648, Lexington, KY 40512. Remember to only use one method of delivery.

  2. Can I change or cancel my direct deposit information?

    Yes, you can change or cancel your direct deposit information with Sedgwick. To do so, complete the Sedgwick Direct Deposit Authorization Form again. Under the "Action Requested" section, choose whether you're changing your direct deposit information or canceling it. If you're changing it, be sure to provide the new bank details. After filling out the form, submit it either by faxing it to the number provided or mailing it. This change or cancellation will stay in effect until you submit a written notice to alter it again, allowing Sedgwick reasonable time to process your request.

  3. What happens if there is an overpayment?

    If there is an overpayment in your disability benefit payments due to an error, Sedgwick and the Arizona State Retirement System (ASRS) have the authority to correct the error by debiting your account for the amount of the overpayment. By submitting the direct deposit authorization form, you grant them permission to make such corrections. However, it's important to understand that Sedgwick or your employer is not responsible for any fees or service charges you might incur as a result of this action.

  4. Are there any fees associated with setting up or using direct deposit for my disability payments?

    Setting up direct deposit for your disability payments through Sedgwick is free of charge, and there are generally no fees for receiving payments directly into your bank account. However, it's important to check with your bank to ensure that they do not have any service charges that could apply, especially in the event of a correction of an overpayment as mentioned above. Sedgwick and the Arizona State Retirement System are not responsible for any costs or charges you may face as a result of receiving these payments or due to the correction of payment errors.

Common mistakes

When filling out the Sedgwick Direct Deposit form for receiving disability benefit payments, people frequently make errors that can delay or complicate the deposit process. Recognizing and avoiding these mistakes can streamline the experience, ensuring that benefit payments are deposited promptly and accurately into the designated account. Here are six common mistakes:

  1. Not specifying the action requested: It's crucial to clearly indicate whether you're establishing a new direct deposit, changing an existing one, or canceling direct deposit altogether. Failing to do so might result in the form being returned for clarification or processed incorrectly.

  2. Entering incorrect financial institution information: The routing number and account number must be accurate. A mistake in these numbers can direct payments to the wrong account or cause delays in processing the deposit.

  3. Incomplete financial institution information: Leaving out the name of the bank, the type of account (checking or savings), or the contact number. Sedgwick needs complete details to process direct deposits correctly.

  4. Forgetting to sign and date the form: Without a signature and date, Sedgwick cannot process the form as it's considered an incomplete document.

  5. Choosing more than one method of delivery: The instructions specify to fax or mail the form, not both. Sending the form via both channels might cause confusion or delays in processing.

  6. Overlooking the prenote verification process: Before the first payment is sent, Sedgwick verifies the account details with a prenote. Ignoring this step and assuming immediate deposit of funds can lead to misunderstandings about when funds will be available.

Avoiding these mistakes when completing the Sedgwick Direct Deposit Authorization Form is essential for a smooth transaction. Careful attention to detail and double-checking the information can prevent errors and ensure timely access to your disability benefits.

Documents used along the form

When processing the Sedgwick Direct Deposit form, especially within the context of long-term disability through the Arizona State Retirement System (ASRS), several additional forms and documents often accompany the direct deposit authorization to ensure a smooth, accurate, and compliant transaction. These documents play pivotal roles in establishing the rightful beneficiary of the disability benefit payments, as well as in maintaining the integrity and accuracy of the direct deposit process.

  • Authorization for Release of Information Form: This document allows Sedgwick to obtain necessary medical, employment, or financial information on behalf of the employee. It's crucial for verifying the legitimacy of the disability claim and determining the appropriate benefit amount.
  • Disability Claim Form: Filed by the employee, this form initiates the disability claim process. It details the nature of the disability, the expected duration of absence from work, and any medical treatment received. It is foundational for Sedgwick's assessment and approval of disability benefits.
  • Physician’s Statement: A critical piece of documentation where the employee's treating physician provides detailed information on the employee's medical condition, including diagnoses, treatment plans, and an estimated timeline for recovery. This document substantiates the disability claim by providing medical evidence.
  • Proof of Identity Document(s): Government-issued identification, such as a driver’s license or passport, is often required to verify the identity of the person submitting the direct deposit form. This is a preventative measure against fraud and ensures that benefits are disbursed to the correct individual.
  • Bank Verification Letter: Occasionally required to validate the existence of the bank account listed for direct deposit, this letter from the financial institution confirms the account number and ownership. It mitigates the risk of funds being erroneously sent to an incorrect or fraudulent account.

These documents collectively support the direct deposit authorization form by providing a comprehensive background for the claim, ensuring that all regulatory requirements are met, and safeguarding against fraud. By meticulously collecting and reviewing these documents, Sedgwick can expediently and accurately process disability benefit payments, thereby minimizing any delays or issues for the beneficiary. Understanding the role of each document within this context not only streamlines the submission process but also enhances the transparency and accountability of the disbursement of disability benefits.

Similar forms

  • Employment Direct Deposit Authorization Form: Just like the Sedgwick Direct Deposit form for ASRS Long Term Disability, this form allows employees to provide their banking details to their employer for the purpose of receiving their paycheck directly into their bank account. Both forms require the employee's financial institution information, including the routing and account numbers, and both enable changes or cancellations to previously authorized direct deposit instructions.

  • Social Security Direct Deposit Enrollment Form: Similar to the Sedgwick form, the Social Security Direct Deposit Enrollment Form is used by individuals who are receiving benefits from the Social Security Administration. It allows them to have their benefits deposited directly into their bank account. Both forms include the need for the recipient's consent, bank information details, and a similar clause that the authorization will stay in effect until a written notice of change or cancellation is received.

  • IRS Direct Deposit Refund Form: This form is used by taxpayers who wish to have their tax refund deposited directly into their bank account. Like the Sedgwick Direct Deposit form, it requires the taxpayer to provide bank account details and consent for the direct deposit. Moreover, both forms facilitate a more efficient transfer of funds to the individual's account compared to traditional check payments.

  • Pension Plan Direct Deposit Authorization Form: Retirees or individuals entitled to pension benefits use this form to request that their pension payments be deposited directly into their bank accounts. Both this form and the Sedgwick Direct Deposit form collect similar types of information, such as the recipient's bank account and routing numbers, and both offer an option to cancel or change the direct deposit instructions.

  • Unemployment Compensation Direct Deposit Authorization Form: This form is filled out by individuals receiving unemployment benefits who prefer to have these funds deposited directly into their bank account. It parallels the Sedgwick form in facilitating direct deposit as a more convenient method for receiving payments, requiring bank routing and account numbers, and offering options for setting up, changing, or stopping the direct deposit service.

  • Veterans Affairs (VA) Benefits Direct Deposit Enrollment Form: Veterans or their beneficiaries use this form to have their VA benefits directly deposited into their bank accounts. Like the Sedgwick Direct Deposit form, it requires personal and bank account information and specifies that the authorization remains effective until a change is requested. Both forms aim to improve the efficiency and security of benefits delivery.

Dos and Don'ts

Filling out the Sedgwick Direct Deposit form is a critical step to ensure your disability benefit payments are properly managed. Pay close attention to the following dos and don'ts to avoid any unnecessary complications.

  • Do verify the accuracy of your financial institution's name, routing number, and your account number before submitting the form.
  • Do choose only one method of delivery, either fax or mail, to send your form to Sedgwick to prevent any confusion or processing delays.
  • Do sign and date the form in the designated area to validate your authorization for direct deposit.
  • Don't leave any fields incomplete, especially your social security number (SSN), type of account, and action requested, as this could delay the processing of your direct deposit request.
  • Don't attempt to enroll in direct deposit without first reading and understanding the terms outlined in the agreement section of the form, to ensure you are aware of your rights and responsibilities.
  • Don't ignore the instructions to provide written notice to Sedgwick in a timely manner if you wish to change or cancel this authorization, as failing to do so could lead to unwanted issues with your benefit payments.

Misconceptions

When it comes to managing disability benefits through Sedgwick, there are several misconceptions about the Direct Deposit Authorization Form. Let's address and clarify seven common misunderstandings.

  • It's complicated to set up direct deposit. Contrary to what some may believe, setting up direct deposit is straightforward. The form requires basic information, such as the name of the financial institution, account number, routing number, and whether the account is checking or savings. This simplifies the process, ensuring that beneficiaries receive their payments with ease.

  • Direct deposit is optional. While it might seem like a choice, opting for direct deposit is a wise decision for ensuring payments are received quickly and securely. It eliminates the risk of lost or delayed checks in the mail, providing more reliability for beneficiaries.

  • Changing or cancelling direct deposit is difficult. It's quite the opposite. To change or cancel direct deposit, one simply needs to provide written notice to Sedgwick, allowing reasonable time for them to process the request. This flexibility ensures that individuals can manage their accounts according to their current needs.

  • Personal information is at risk. Sedgwick requires financial information solely for the purpose of verifying account numbers and routing information. This is a common practice among financial transactions, and safeguards are in place to protect personal information, emphasizing the security of the direct deposit process.

  • You cannot control the date of deposit. While it's true that the deposit will not be posted until the date of the monthly benefit payment, this predictability is beneficial. It allows beneficiaries to plan their finances around a consistent payment schedule, knowing exactly when funds will be available.

  • Sedgwick and employers are responsible for any costs or service charges. In fact, the form clearly states that Sedgwick or the employer is not responsible for any costs or service charges incurred by the beneficiary as a result of the Electronic Funds Transfer actions. This makes it important for individuals to understand their financial institution's policy regarding direct deposits.

  • Submitting the form is a lengthy process. The form can be submitted easily by fax or mail, and Sedgwick requires only one copy. This streamlined approach is designed to minimize effort from the beneficiary, making the process of establishing, changing, or canceling direct deposit as efficient as possible.

Understanding these aspects of the Sedgwick Direct Deposit Authorization Form can alleviate concerns and misconceptions, ensuring that individuals are better informed about managing their disability benefits securely and efficiently.

Key takeaways

Understanding how to correctly fill out and use the Sedgwick Direct Deposit Authorization Form is essential for Arizona State Retirement System employees seeking long-term disability benefits. Here are five key takeaways to assist in this process:

  1. Authorization is Mandatory for Direct Deposit: Employees must authorize Sedgwick and their employer to deposit disability benefit payments directly into their bank account. This authorization is crucial for the direct deposit process to begin and will remain in effect until the employee decides to change or cancel it with a proper notice.

  2. Accurate Account Details are Required: Providing precise financial institution information, including the account number and transit/routing information, is necessary. This information allows Sedgwick to verify the account and ensure accurate and timely deposit of benefit payments.

  3. Options for Action: Employees have the option to establish a new direct deposit, change an existing one, or cancel direct deposit entirely in favor of receiving benefit payments by mail. Clear indication of the desired action helps Sedgwick process requests efficiently.

  4. Understanding the Timing of Deposits: It is important to know that deposits will not post to the account until the date of the monthly benefit payment. This understanding can help manage expectations regarding when funds will be available in the account.

  5. Potential for Correction of Overpayments: Sedgwick and the employer reserve the right to correct any electronic funds transfer errors, including erroneous overpayments, by debiting the employee's account for the amount overpaid. Awareness of this possibility is important for financial planning and monitoring of account balances.

When completing and submitting the Sedgwick Direct Deposit Authorization Form, ensure that all requested details are accurate and complete. Employees can submit the form via fax or mail, but only one submission method is necessary. Such meticulous attention to detail and understanding of the process can lead to a smoother experience in receiving long-term disability benefits.

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