Disability Disclosure Authorization

We want you to get the disability benefits you deserve. 

First, we need your authorization to collect information to support your claim. To give us that authorization, it's important that you complete the Disclosure Authorization.  

You can mail or fax a signed Disclosure Authorization Form to us, so we can begin processing your request for benefits. 

Mailing address and fax:

New York Life Group Benefit Solutions
Paper Intake Team
P.O. Box 709015
Dallas, TX 75370-9015
Fax: 800-642-8553


New York Life Group Benefit Solutions products and services are provided by Life Insurance Company of North America and New York Life Group Insurance Company of NY, subsidiaries of New York Life Insurance Company.

Life Insurance Company of North America is not licensed in New York and does not conduct insurance business in New York.