Disability Claims: More Information

Please fill out the following form so that we may better assist you. The more information we receive about your disability claim, the more effectively we will be able to evaluate your case.

  • Please choose the appropriate option so we can better respond. If your issue is not covered in the choices above or if you have multiple items, please enter them in the "Other" field below.
  • Fax denial toll-free to: (866) 606-8496