Claim and Service Forms

If you need to file a claim, or just need additional information about a claim, please visit our My Colonial Life policyholder website.

For more information on claims or other service topics, view our Policyholder Service Guide.

Online Forms

  1. Online

    Health/Wellness Claim (less than a year old)

    Submit online filing of health or wellness screening claims that are less than a year old.

  2. Online

    Doctor's Office Visit - Medical Bridge 3000 (less than a year old)

    Submit online filing of doctor's office visit claims for Medical Bridge 3000 that are less than a year old.

  3. Online

    Loss of Life (Death) Notification Form

    Submit Loss of Life Notification online.

Services Information Guide

  1. #43233

    Service Guide for Policyholders

    This helpful flier provides information on finding the most up-to-date claim forms, submitting a claim and selecting optional services on the claim form. The form also provides helpful tips about the claims process, how the policy works and when to contact the service center.

Claim Forms

  1. #67715

    Accident

    This PDF should be used to submit an accident claim. If you are also filing for disability benefits, please complete the Disability claim form.Watch the Claim VideoView the Claim Quick Tips

  2. #74273

    Cancer

    This PDF should be used to submit a cancer claim.Watch the Claim VideoView the Claim Quick Tips

  3. #74606

    Group Supplemental Indemnity

    This PDF should be used to submit a Group Supplemental Indemnity claim.

  4. #64387

    Disability

    This PDF should be used to submit a disability claim.Watch the Claim VideoView the Claim Quick Tips

  5. #46988

    Continuing Disability

    This PDF should be used to submit additional information for your on-going disability claim.

  6. #70067

    Health/Wellness Claim (over a year old)

    This PDF should be used for the express filing of health or wellness screening claims that are over a year old.

  7. #49507

    Pregnancy Claim

    This PDF should be used for the express filing of pregnancy claims once you deliver. If you are filing for complications prior to delivery, please complete the Universal Claim Form.

  8. #69121

    Doctor's Office Visit (Medical Bridge 3000 and Group Medical Bridge 1.0)

    This PDF should only be used to submit a claim form for a doctor's office visit if you have a Medical Bridge 3000 policy.

  9. #100713

    Medical Bridge

    This form can be used to submit a Group Medical Bridge 1.0 or Medical Bridge claim.Watch the Claim VideoView the Claim Quick Tips

  10. #65017

    Critical Illness

    This PDF should be used to submit a claim for the critical illness benefit.Watch the Claim VideoView the Claim Quick Tips

  11. #60316

    Group Supplemental Hospital Confinement/Indemnity

    This PDF should be used to submit a claim under the Group Supplemental Hospital policy offered by your employer, if available where you work.

  12. #57930

    Catastrophic Accident

    This PDF should be used to submit a claim for the catastrophic accident benefit.

  13. #08727

    Universal Claim Form

    This PDF can be used to submit a claim for disability, cancer, accident, and hospital confinement.Watch the Claim VideoView the Claim Quick Tips

Service Forms

  1. #18514

    Conversion Request Form

    This form should be used when your premiums are no longer being payroll-deducted.

  2. #57644

    HIPAA Authorization

    This PDF should be completed and returned with each claim form submitted.

  3. #17075

    Change of Beneficiary Form

    This PDF form should be used to add or modify the designated beneficiary on a policy.

  4. #N/A

    Change of Beneficiary Frequently Asked Questions

    This PDF is a guide to the most common questions about the change of beneficiary form.

  5. #14001

    Change of Ownership Form

    This PDF form should be used to update owner and/or contingent owner information on a policy.

  6. #05897

    Request For Service

    Use this PDF form to request changes to personal data, request a Beneficiary Change Form, or to exercise policy provisions.

  7. #73712

    Request For Service Form — Life

    This PDF form should be used to request a loan, withdrawal, or cancellation/surrender of your life policy.

Formularios de Servicio

  1. #100695

    Formulario De Cambio De Titularidad

    Este formulario PDF debe ser usado para el cambio de informacion de el titular y/o el titular eventual de la poliza.

  2. #70089

    Formulario para cambio de Designación de Beneficiario

    Este formulario se usa para cambiar la designación de su beneficiario primario.

  3. #51164

    Formulario para la Presentación de una Reclamación

    Este formulario se puede usar para procesar su reclamación.

  4. #18397

    Formulario para Solicitar Servicio

    Use este formulario para cambiar su dirección u otra información personal, cambiar su beneficiario o para efectuar otros cambios relacionados con su póliza.