File an Accident or Health Insurance Claim - Policyholder Payment

"Let’s make this easy" are words we take to heart, whether it’s when we’re helping you find the right coverage for your needs, or now, when you need to file a claim. We want to make filing your claim as easy as possible because chances are, you’re looking for our help during a difficult time of your life.

To file a claim for accident and health coverage, first print or view the Claim Form Instructions below, then simply click on your state of residence from the list below, print out the form and complete it. You can also complete the first page online and print it out; however, you cannot submit the form electronically. Please note, specific sections of the form must be completed by your employer and doctor.

Once complete, mail it to:

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

We appreciate the trust you place in us. Combined Insurance – a good decision

Claim Form Instructions

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

New York Form
English / Spanish

Health Screening, Preventative Care and Accident Claims:

You may qualify for immediate submission over the phone if:

  • Your policy provides a Health Screening or Preventative
    Care benefit, and you are reporting a claim for these benefits
  • You had an accident and you do not intend to file for disability

Please call 1-800-225-4500, and ask for TeleClaims

TeleClaims Service is available for policies issued in the continental U.S.(excluding New York), Monday-Friday, 8:00 a.m. to 4:00 p.m. Central

Claims Forms

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

English / Spanish

New York Form

English / Spanish

Back to File a Claim

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