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Claim Information


Available Claim Forms

To submit a claim use one of the appropriate links below. If none are available for your particular claim, please contact us directly.

New York Disability

Arch- Notice and Proof of Claim for Disability Benefits.pdf

Guardian - Notice and Proof of Claim for Disability Benefits.pdf

Hartford - Notice and Proof of Claim for Disability Benefits.pdf

Mutual of Omaha - Notice and Proof for Disability Benefits.pdf

Standard of NY - NYS Disability Claim.pdf

Standard Security - Notice and Proof of Claim for Disability Benefits.pdf

Unum - Notice and Proof of Claim for Disability Benefits.pdf

 

Paid Family Leave - New York

 Arch - Bonding Family Care Military Leave.pdf

 Guardian - Notice and Proof of Claim for Disability Benefits.pdf

Lincoln - Bonding Family Care Military Leave.pdf

Standard Life - Bonding Family Care Military Leave.pdf

Hartford - Bonding.pdf

Hartford - Military Leave.pdf

Hartford - Family Care.pdf

Hartford - Military Leave.pdf

Standard Security - Military Leave.pdf

Wesco - Bonding.pdf

Wesco - Family Care.pdf

 

Administrative Forms

Disabilities Survey Form.pdf

DB135 Voluntary Coverage (Non-Contrib).pdf

DB120.1 Request Form.pdf

DB136 Voluntary Coverage (Contrib).pdf

DB212-3 Officer Exclusion.pdf

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