Claim Form

If you did not receive a claim form in the mail, you can print a claim form by clicking the link below. Fill out the Claim Form completely and mail it to the address on page 4 of the Claim Form.

If you did not receive a Claim Form in the mail and would like to file your claim electronically on this website, please call the administrator at (877) 524-8480 to obtain your claim number and control number. Enter these numbers on the "File a Claim" page of this website to begin filing your claim electronically.

The above document is in PDF format. Acrobat Reader is required to view the PDF. You may already have the Adobe Acrobat Reader on your computer or on disks that came with your computer. If you do, you won't need to download Adobe Acrobat. If you do not have Acrobat, you may download the Free Adobe Acrobat Reader.