Submit the completed form to Colonial Life via mail, fax, or as instructed in the form's guidelines. Fax: 1.866.887.6644. Mail to: Colonial Life & Accident Insurance Company, Attn: Disability Benefits, P.O. BOX 100195, Columbia SC 29202. Ensure that all required sections are fully completed, and necessary signatures and supporting documents are included to prevent processing delays. For questions, call 1.800.325.4368.

Ensure timely submission of the Disability Claim Form to avoid delays in claim processing. Keep track of any deadlines mentioned in your policy documentation.

The purpose of the Colonial Life Disability Claim Form is to facilitate the process of filing a claim for disability benefits due to accident or sickness. This form collects essential information about the claimant, policy owner, and the circumstances surrounding the disability, ensuring that Colonial Life can accurately assess and process the claim. Additionally, it provides necessary fraud warnings and certification statements to maintain the integrity of the claims process.

• 1. Claimant name: Full name of the individual making the claim.
• 2. Claimant Social Security Number: Social Security Number of the claimant.
• 3. Policy Owner name: Full name of the policy owner.
• 4. Policy Owner Birth Date: Date of birth of the policy owner.
• 5. Mailing Address: Address where correspondence related to the claim should be sent.
• 6. Accident Details: Information about the accident, including date and description.
• 7. Medical History: Details of prior medical treatment for similar conditions.
• 8. Doctor Information: List of doctors who treated the claimant, including contact details.
• 9. Hospital Confinement: Details of hospital stay if applicable, including admission and discharge dates.
• 10. Certification and Signatures: Required signatures from the claimant and policy owner certifying the accuracy of the information provided.

Failure to submit this form correctly and within the required timeframe can lead to delays or denial of your disability claim.

• Claim Delays: Incomplete forms can result in processing delays.
• Claim Denial: Incorrect or missing information can lead to claim denial.
• Lack of Benefits: Failure to submit may result in loss of entitled benefits.

• 1. Accident Disability Claims: When an accident has caused a disability that prevents work.
• 2. Sickness Disability Claims: When an illness has caused a disability that prevents work.
• 3. Updating Claim Details: Providing additional or updated information for an existing claim.
• 4. Assigning Benefit Rights: Assigning the right to benefits to a healthcare provider or other entity.
• 5. Certifying Claim Information: Certifying the accuracy and truthfulness of the claim details provided.