If you have questions regarding the claims process, please contact us at 1-800-522-0406.
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This site will guide you through the steps to complete and submit a Disability Claims statement.
You will be asked a series of questions that will take approximately 10 minutes to complete. The steps you'll need to complete are indicated at the top of each page. Your answers will be automatically transferred to the Disability Claim form when you are done.
Sign the document electronically and click the "Submit" button. You can view and print a copy of the form for your personal records, the form we receive is the official record of your claim submission.
The online claims application does not allow you to save your work and complete it later and the web session will time-out after 30 minutes of inactivity. Thus before you begin, please have the following information available:
Employers' names and phone numbersDate and description of disabilityPhysicians' names and phone numbersHospital name and hospitalization dates (if applicable)Personal identification information (Social Security Number, Date of Birth, etc.)Other Income or benefits you've applied for and date you applied (e.g. Workers' Compensation, Fully Paid Sick Leave)
Once you have the required information, select the "Start Online Claims Submission" button to begin the process.