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Online form

Completing an online Claim Form is confidential and convenient. As you fill out your claim form online, you’ll be able to find other useful online documents and resources you may need. You can also save your progress and return to the form, allowing you to take the time you need and go at your own pace.

Complete your claim form online.

Fillable PDF or Print

You can complete your claim form by fillable PDF or download the claim form, print it, and complete it on paper. If you require a paper version of the Individual Claim Form to be sent to you, please contact The Administrator at  1-833-252-4220 (Toll-free).

Individual Claim Form

Representative Claim Form

Interactive guide - individual

Need help getting started with your claim?

Try the Interactive Guides, our step-by-step online tools that help you fill out your Claim Form at your own pace. The Guides are narrated for your convenience

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