Claims


Starting a Claim?

We are ready to help! Simply print the appropriate form and call our office at (203) 483-0044 or toll-free (888) 280-0009. Please dial extension 204 for Anne or 206 for Susan. They will help guide you through the process.

Disability Claim Form

Download

Accident Claim Form

Download

Cancer Claim Form

Download

Critical Illness Claim Form

Download

Dental Claim Form.pdf

Download

Health and Wellness Claim Form

Download

Hospital Confinement Form

Download

Pregnancy Claim Form

Download

Universal Claim Form

Download

Did Your Disability Get Extended?

Complete the following disability form and fax it to our local office at (203) 483-0011.

Continuing Disability Claim Form

Download

Need to Make a Change?

Complete the Request for Service form below and fax it to our local office at (203) 483-0011. Our staff will notify your employer and Colonial of the changes you have requested.

Request for Service Form

Download

Beneficiary Change Form

Download

Not sure where to start?

No problem! Just give us a call at
(203) 483-0044 or toll-free (888) 280-0009 and we will be more than happy to assist you!