You’ll need to provide the following information:

• Your employer’s name
• Your group policy number
• Your name, date of birth and Social Security Number
• Your contact information (mailing address, email and phone number)
• The last day you were at work
• The first day you were unable to work
• Information about your injury or illness
• Your treating medical provider’s contact information (name, phone number and fax number)

Information will also be needed from your employer and your treating medical provider to substantiate your claim. We will need a signed medical authorization in order to request medical records. Once your claim is created and assigned to a claim examiner, you will be informed of any additional information needed to complete your claim.