File an Insurance Claim - Payroll Deducted Premiums

When you need us most, the last thing you want is a difficult, drawn out claim process. That's why Combined Insurance is different ... we strive to make it easy to file insurance claims.

To file Combined Insurance claims for premiums which are payroll deducted*, print the Claim Form Instructions, then simply click on your state of residence from the following list and print out the appropriate form. Complete the form; specific sections must be completed by your employer and doctor, and return the form to us at:

Combined Insurance - Worksite Solutions
Claim Department
P.O. Box 6700
Scranton, PA 18505-0700
Toll-free: +1-800-544-9382

Claim Form Instructions

U.S. Form (All States with the exception of New York)

New York Form

NEW - Authorization to Disclose (All State with the exception of New York)

NEW - Authorization to Disclose (New York Form)

If your premium is not paid through payroll deductions, please click here.

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