Hartford Voluntary LTD Conversion Form
As a terminated employee or an active employee who is no longer full-time, you may be eligible to convert to an individual policy.
Employees must complete this form if they want to convert their voluntary long term disability (LTD) coverage with Hartford. For questions about how to
complete this form, contact Sonya Stewart at HR-Benefits at 681-4436. PLEASE NOTE: Conversion may be available if the policy was in effect for at least a year.
The Duke Disability Plan is not eligible for conversion and this form cannot be used.
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* Some Duke HR forms may require you to list your Duke Unique ID. If you do
not know or are unsure of your Duke Unique ID, you can look it up
here.
** Some forms available on this web site are in Adobe Portable Document Format (PDF). You will need
Adobe Acrobat Reader
to view and print these forms.
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