If You Need to File a Claim, Call Our Office First
Claim forms can be sent to you via mail, fax or e-mail.
You are required to continue to make premium payments until you return to work, or you reach premium waiver.
Once your claim form has been forwarded to the insurance company, call the insurance company directly at the number listed for status updates.
For Transamerica Claims:
Please provide complete and legible responses to ensure that your claim is processed as quickly as possible. DO NOT cross out, write over or whiteout information on the claim form. If a correction is needed, a new page must be used. Do not skip/leave any questions blank. If a question does not apply, write “N/A”. Please carefully proof all sections/pages of your claim form for accuracy/completeness before it is submitted.
Missing, inaccurate, or contradictory information will cause a delay in processing time.
- Fill out pages 1 & 2 completely.
- Complete the HIPAA authorization pages 1 & 2.
- Complete the Medical History form pages 1 & 2.
- The doctor who is treating you fills out page 3. The doctor must answer all questions.
If you leave the form with the Physician's office, please ensure they know to fax the form to (732) 414-1840. - If you are out because of an on the job incident (Worker's Comp), an initial injury report is required.
Call the UPS Safety Department phone # (212) 631-6153. Request the injury report be faxed to (732) 919-3828. - If you are out because of a motor vehicle accident, a copy of the police report is required.
- Fax the completed forms and your most recent paystub to (732) 414-1840 for employer verification.
- Call the office 20 minutes after your fax has been sent, to confirm we received all pages.
- We will complete the employer section and forward your claim form to Transamerica.
- It can take up to 14 business days to process your claim (depending on claim volume).
For UNUM CLAIMS:
- Initial Claim:
- Fill out pages 1, 3, and 7.
- Have the doctor who is taking care of you fill out page 5. The doctor must fill this form out completely.
- Fax the form and your most recent paystub to (732) 414-1840 for employer verification.
- Continuing Claim:
- Fill out page 1 and the top of page 3. Sign the Certification section of page 3.
- Have the doctor who is taking care of you fill out page 4. The doctor must fill this page out completely.
- Fax the form to (732) 414-1840 for employer verification.
- Call the office 20 minutes after your fax is completed to confirm we received all pages.
- We will complete the employer section and forward your claim form to UNUM.
- Once you receive notice from UNUM that your claim is received, it can take up to 14 business days to process your claim (depending on claim volume).
For Paul Revere Claims:
- Fill out pages 1, 2, 3, and 7. If this claim is for an accident, fill out section "C" on page 5.
- The doctor who is taking care of you fills out page 4. The doctor must fill in dates of disability.
- Fax the form and your most recent paystub to (732) 414-1840 for employer verification.
- Call the office 20 minutes after your fax has been sent, to confirm we received all pages.
- We will complete the employer section and forward your claim form to Paul Revere.
- It can take up to 14 business days to process your claim (depending on claim volume).
For Allstate NY Claims:
- Fill out pages 1, 2, and 3. If this is for pregnancy, fill out the top of page 4.
- The doctor who is taking care of you fills out page 5. The doctor must fill in dates of disability.
- Fax the form and your most recent paystub to (732) 414-1840 for employer verification.
- Call the office 20 minutes after your fax has been sent, to confirm we received all pages.
- We will complete the employer section and forward your claim form to Allstate.
- It can take up to 14 business days to process your claim (depending on claim volume).