Ones) Toll-free: 1-800-447-2498 Call toll-free Monday through Friday, 8 a.m. to 8 p.m. (Eastern Time). For use with policies issued by the following Unum Group Unum subsidiaries: Unum Life Insurance Company of America Provident Life and Accident Insurance Company The Paul Revere Life Insurance Company OUR COMMITMENT TO YOU We understand that a disabling illness or injury creates emotional, physical and inancial challenges and we want to do whatever we can to help you. You have our commi.
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How to fill out the UNUM CL-1104 online
Filling out the UNUM CL-1104 Short Term Disability Claim Form online can be straightforward if you follow the right guidelines. This guide aims to provide a clear, step-by-step process to help you accurately complete this essential document for beneficial claims.
Follow the steps to complete the UNUM CL-1104 successfully.
- Press the ‘Get Form’ button to access the UNUM CL-1104 and open it in your preferred editor.
- In the top section of the form, enter your name and date of birth in the designated fields. Ensure this information is consistent across all pages.
- Complete the Employee Statement on pages 4-5 thoughtfully. Provide details regarding your personal information, including contact details, social security number, and employer's information.
- Fill in the information pertaining to your disability, specifying whether it’s due to an illness or injury, including further details on your medical condition and relevant dates.
- If applicable, fill out the Authorization to Share Information section on page 6, allowing UNUM to communicate with designated individuals regarding your claim.
- Ensure the last page is signed and dated, confirming your understanding and consent regarding the claims process and the fraud warning.
- Once all sections are completed, save your changes. You can then download, print, or share the form with the necessary parties.
Complete your UNUM CL-1104 form online to ensure a smooth claims process.
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