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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

Long-term disability claim form (123Kb)

Short-term disability claim form (178Kb)

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

Employers in the state of New York

Employers in all others states

Union Security Life Insurance Company of New York
PO Box 972208
El Paso, TX 79997-2208
Phone: 800.451.4531
Fax: 866.439.1695

Assurant Employee Benefits
PO Box 972030
El Paso, TX 79997-2030
Phone: 800.451.4531
Fax: 816.881.8768


3. Have a question about filing your claim?

Call 800.451.4531 and select option 1, 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.