File an Insurance Claim - Standard Premiums

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

To file Combined Insurance claims for standard premiums*, print the Claim Form Instructions, then simply click on your state of residence from the following list and print out the appropriate form. (If your premium is paid through your employer using PAYROLL DEDUCTION, CLICK HERE.) Complete the Combined Insurance claim form; specific sections must be completed by your employer and doctor, and return the form to us at:

Combined Insurance
Claim Department
P.O. Box 6700
Scranton, PA 18505-0700

Please Note:

Combined Insurance customers residing in the state of Connecticut who have been adversely affected by the October 2011 snow storm may be eligible for an extension of the grace period for premium payments as well as the timeframe for submitting claim proof of loss. If you need assistance or have any questions, please do not hesitate to contact our Customer Care Center at 800-225-4500. In addition, a letter containing further details will be mailed to policyholders who reside in the affected areas shortly.

Combined Insurance customers residing in the states of New Jersey, Rhode Island, Vermont and certain counties in North Carolina (as specified within that state's emergency bulletin) who have been adversely affected by Hurricane Irene, are eligible for an extension of the grace period for premium payments as well as submitting claim proof of loss.  If you need assistance or have any questions, please do not hesitate to contact our Customer Care Center at 800-225-4500.  In addition, a letter will be mailed to you shortly with further details.

Claim Form Instructions

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

New York Form
English / Spanish

Claim Forms

 

 

*If your premium is paid through payroll deductions, please click here.

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