Claim's Fax Cover Sheet

To File Accident/Disibility Claims

Quick Tips for Expediting Claims

Short-Term Disability (Due to Sickness or Pregnancy)

Short-Term Disability (Due to Accident or Injury)

Cancer

Continuing Disability

Injury

Dental

- Wellness Forms -

Accident Indemnity Wellness

Hospital Indemnity Wellness

Cancer Indemnity Wellness

- Formularious de Reclamaciones en espanol -

Instrucciones

Incapacidad

Incapacidad Continua

Cancer

CLAIM FORMS ARE AVAILABLE IN PORTABLE DOCUMENT FORMAT (PDF) AND CAN BE VIEWED WITH ADOBE ACROBAT READER. IF YOUR COMPUTER DOES NOT HAVE AT LEAST ADOBE ACROBAT READER 8.0, WE RECOMMEND YOU DOWNLOAD IT.