LONG TERM CARE CLAIM FORM The Benefits Center P.O. Box 100196, Columbia, SC 29202-9975 www.unum.com Phone: 1-800-693-4988 Fax: 1-800-268-1377 Call toll-free Monday through Friday, 8 a.m. to 8 p.m.

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How to fill out the Unum CL-1158 online

Filing a long-term care claim can feel overwhelming, but understanding how to fill out the Unum CL-1158 form online can simplify the process. This guide offers detailed, step-by-step instructions to help ensure your claim is filled out correctly and submitted in a timely manner.

Follow the steps to complete your Unum CL-1158 form online.

  1. Press the 'Get Form' button to acquire the Unum CL-1158 form and open it in your preferred document editor.
  2. Begin by providing your personal information, including your full name, mailing address, and the best contact number. Ensure that your date of birth and Social Security number are accurately entered.
  3. If you are filling out this form on behalf of the policy holder, include your information and your relationship to them.
  4. Specify the medical condition(s) that necessitate your need for assistance with Activities of Daily Living (ADLs) or supervision due to cognitive impairment.
  5. Indicate which ADLs you require assistance with by checking the applicable options, including bathing, dressing, toileting, transferring, and eating.
  6. Complete the section regarding your need for supervision. Provide details on the reasons for supervision and how often it is received.
  7. Identify your current living situation by selecting either 'Your Residence' or 'Care Facility' and provide the necessary contact information.
  8. List all other care providers who have been involved in your treatment or supervision, including their contact details and the duration of care.
  9. Fill in the information regarding medical providers related to your conditions and treatments, ensuring to include their contact details.
  10. Finally, review all sections for accuracy, sign the form, and include any required authorization documents for representation if applicable. Once complete, you can save changes, download, print, or share the form as needed.

Start completing your Unum CL-1158 form online today to ensure that your claim is processed efficiently.

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