Assurant Employee Benefits

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Disability Claim Forms

This service is offered by Assurant Employee Benefits to employers who wish to file a disability claim.

The information requested is required for us to begin reviewing your employee's claim. It's important that the information be complete and accurate information to avoid delays.

Submit a disability claim

1. Choose the form you need:

PDF Format Our brochures are available in Portable Document Format (PDF). To view the brochures, you may need to download the latest version of Adobe® Acrobat® Reader which is available free at www.adobe.com.

Long-term disability claim form (123Kb)

Short-term disability claim form (178Kb)

2. Mail or fax the completed and signed form, along with any requested documentation, to:

Kansas City Benefit Center

Minneapolis Benefit Center

Indianapolis Benefit Center

PO Box 419568
Kansas City MO 64141-6568
Phone: 800.451.4531
Fax: 816.881.8527

PO Box 39844
Minneapolis, MN 55439-0844
Phone: 800.325.8385
Fax: 952.920.4577

PO Box 40918
Indianapolis, IN 46240-0918
Phone: 800.283.3636
Fax: 317.201.2201

 

3. Have a question about the claim form?

Call 800.451.4531 and select option 3, between 8 a.m. and 5 p.m. Central Time. If you call outside this time frame, please leave a voicemail message and a representative will respond the next business day.