Disability Insurance Claim Denial Questions and Inquiries

Submit your disability insurance case review request or question:

Do you have a question about a disability, long term care, life or health insurance claim denial? Please submit your question or case review request through this form.
Contact Information:
Name
Area Code + Phone Number (Day):
Area Code + Phone Number (Nights):
Area Code + Phone Number (other):
Best Time to Call:
E-mail Address:
State of Residence (important!):
(Laws vary by state, this information will be helpful in determining your rights. Please use your State's 2 letter abbreviation)
Insurance Company:
What is your Disability?
Amount of Monthly Benefits (approximate)
Type of Policy:	Group Individual
Was your policy obtained through your employer?	Yes No
Name of employer at the time you purchased your policy:
Has your claim been wrongfully denied?	Yes No
When was claim denied?
Other Information
Verification	Please enter the characters from the image below to submit this form. digital printout-please type these letters in the box above: capital X lower case y lower case w

Click the Submit button and your message will be sent. If you do not receive a response within 2 working days please contact us by telephone. We provide service to clients nationwide!
Toll - Free 1.800.264.2082

This form sends results by E-mail, which is not a secure method of transmittal. If you require confidentiality, please click here for our fax form or contact our office by phone: 800.264.2082 Your IP Address will be logged for purposes of verifying the validity of your submittal.

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please click here to visit Insurance Consumers.

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Toll-Free Nationwide: 1.800.264.2082
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