Short-Term Disability Claim Form
Long-Term Disability Claim Form
Disability Disclosure Authorization
Physician’s Statement of Disability
Medical Request Form
State Income Tax Withholding
Request for Federal Income Tax Withholding
Electronic Fund Transfer Authorization
Long Term Disability-Educator Plan
Authorization to Release Information to Third Party
Customer Forms
Customer Resource Forms
Please preview and download the necessary claim-related forms from the list below.
Documents on this website are PDFs. You will need to save them to your computer, complete the forms and submit.
Life and Accidental Death Proof of Loss Form
Accidental Dismemberment Proof of Loss Form
Accelerated Benefits Claim Form
Group Universal Life and Group Variable Universal Life Claim Form
Funeral Assignment Job Aid
Disclosure Authorization for a Deceased’s Claim
Disclosure Authorization for a Living Insured’s Claim
Total and Permanent Disability/Waiver of Premium
Accident Insurance Claim Form
Critical Illness Insurance Claim Form
Hospital Indemnity Insurance Claim Form
Attending Physician Statement for Accident Form
Attending Physician Statement for Critical Illness Form
Attending Physician Statement for Hospitalization Form
Health Screening Benefit Claim Form
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