Submit a Claim

You may prepare and submit a Claim Form as follows:

1.) Request a Claim From by calling the Claims Administrator (details below) or Download/Print a Claim Form using the link below and submit your completed Claim Form and supporting documents by mail.

Claim Form

2.) Fill out a Claim Form and upload supporting documents electronically using the link below.

On-line Claims App

If you have any questions please contact the Claims Administrator at (866) 482-5436 or