Follow the steps to complete your claim form online.

1. Click the ‘Get Form’ button to access and download the form to your device.
2. Complete the Employer Section at the top of the form. Ensure to sign and date it as indicated. This information is essential for your claim to proceed.
3. If applicable, attach a copy of the enrollment history for any Group Life coverage elected by the employee. This provides necessary context for the claim.
4. Print and provide the remaining sections of the form, along with the instruction sheet, to the employee. Instruct them to fill out the Employee Sections and return everything to The Hartford.
5. Ensure the employee detaches the Attending Physician's Statement from the form and submits it to their physician. This statement must be completed and returned separately.
6. Once the Employee Section is fully completed, instruct the employee to read, sign, and date the Important Notice and Claim Certification as well as the Authorization at the bottom of the Employee Section.
7. Collect the fully finished Employee Sections, ensuring that all attachments are included.
8. Verify all required documents, such as the Attending Physician’s Statement, are sent within the submission period specified by the applicable policy.
9. Submit the completed Employer Statement and all necessary attachments directly to The Hartford via mail, fax or email. The mailing address is provided on the form.
10. Follow up with The Hartford to confirm the receipt of all submissions within the specified submission period.

Start completing your The Hartford LC-3763-22 form online today to ensure a smooth claims process.