HealthMark specializes in FMLA and disability requests.

What’s the best way to send you my request?
Email us at clinicalforms@healthmark-group.com  Please include your full name, your date of birth, the name of your doctor and the name of your healthcare facility along with their address and phone number.

What if I have more than one form?
You can submit multiple forms in the same email, but keep in mind that there may be additional charges for additional forms or forms with more than 5 pages.

What information do I need to provide with my form?
We recommend providing as much information as possible to expedite the process. Key information includes when you need to be out of work and when any procedures are to be performed.

What happens after you receive my form?
Once we receive your form, we will verify key information and send you an invoice. Once the invoice is paid, we will process your form and send it for signature. When the form has been reviewed and signed by your physician, you will receive a notice that it is available for download at https://requestmanager.healthmark-group.com/

How long does it take to receive my completed form?
It takes approximately seven days to process an FMLA or disability form request. While this might seem like a long time, keep in mind that HealthMark must coordinate communications with a number of different parties that may include your doctor, your insurance company, your employer and you. These communications must follow strict guidelines and procedures to ensure the safety of your personal health information. And all of this takes time.

Can I get a copy of my form?
Yes, we recommend that you download a copy of your form or ask that it be sent directly to you. This helps you ensure that all required parties have the requested information and secures a copy for future reference.

Why are you charging me for my doctor to fill out paperwork?
This is a tough one – all you want is your completed form so you can focus on your recovery, and you find out that you have to pay for that paperwork. In order to process and complete an FMLA or disability request form, there are a lot of associated costs and resources required. HealthMark has to engage clinical experts, communicate with a number of different parties like your insurance company and coordinate with your doctor in order to complete the form. The cost we collect from you covers that expertise, just like the cost of an office visit covers the expertise of your doctor. Unfortunately, most insurance providers do not cover this service; however, we recommend submitting a receipt to see if your insurance provider or employer will reimburse you directly.

I received a request for payment, but I didn’t request a form to be completed?
Many times when you have an injury and need to be out of work, your employer or insurance company will contact your doctor to have a form completed. This is often done without your employer or insurance company contacting you. So even though you did not initiate the request for a form, you must work with HealthMark to process your FMLA or disability request.

I received my form, but I noticed something needs to be updated.
Please email clinicalforms@healthmark-group.com with as much detail as possible about what needs to be updated. Be sure to include your contact information so our team can contact you if there are issues with the requested updates. It is important that you reach out to HealthMark for any requested updates and not your doctor’s office, as your doctor’s office will not be able to help.

What if I lost my form?
Unfortunately we can’t help locate lost forms. You should contact your insurance company or employer to get a new one.

My insurance company says they didn’t receive the form, what can I do?
We can re-send the completed forms for you, and you can send the forms directly to your insurance company or anyone else who may request a copy. We strongly recommend you have forms released to you as there are often bottlenecks in large insurance companies that delay your claim from being processed.

To Submit a Request for a DMV Placard:

1. Download the form from the California DMV website here.
2. Complete sections 1, 2 and 3 on the form (please note: in section 2a, select temporary DP parking placard).
3. Submit your completed form to clinicalforms@healthmark-group.com with the following information in your email:
   • • Your name
     • Your contact information
     • Your physician’s name
     • Your physician’s practice (ex: Orthopedic Specialists)

     Once we have completed your form, you’ll receive an email with details on how to make a payment and access your form. Please note that all DMV placard forms need to be returned to a state-run DMV center and not an AAA center.

     To Submit an EDD Form:

     You have three different options to request a paper Claim for Disability Insurance (DI) Benefits (DE 2501) form. Please note that you should allow up to 10 days to receive the form no matter which option you choose.

     1. Visit this website, and search for from #2501. You can then order the form and have it mailed.
     2. Visit an SDI office.
     3. Call 800-480-3287 and select DI information option 3.

     Once you have received the form, submit your completed form to clinicalforms@healthmark-group.com, and be sure to include the following information in your email:

     • • • Your name
         • Your contact information
         • Your physician’s name
         • Your physician’s practice (ex: Orthopedic Specialists)