Claim Forms Library

To file your long-term care insurance claim, the proper claim form from your carrier must be used. For your convenience, we have provided claim forms from the most popular carriers.

Allianz Forms
Allianz Claim Form
Bankers Forms

Bankers Life Claim Initiation Forms

Bankers Life Long Term Care Form

CalPERs Forms

CalPERs Filing a Claim—What Is Needed?

CalPERs Agency Provider Form

CalPERs Agency Statement

CalPERs Appeal Form

Assignment of Benefits Independent Provider

Assignment of Benefits

Assignment of Benefits Service Provider

Authorization to Release Individual Personal Representative Form

Authorization Disclose Health

How to File a Claim

Independent Provider Packet

Independent Provider Weekly Time Sheet

CalPERs Online Claim Form

CalPERs PHI Form

CalPERs Reconsideration Form

CNA Forms

CNA Authorization To Release Info Disclosure Form

CNA Claim Form

CNA Claimants Statement

Conseco Forms

Conseco Claim Form

Genworth

Genworth insurance claims must be submitted online.

Genworth Forms

Long Term Care Insurance Form

John Hancock

John Hancock insurance claims must be submitted online.

Lincoln Financial Group Forms

Lincoln Financial Group Assignment Of Benefits

Lincoln Fnancial Group Care Provider Assessment

Lincoln Financial Group HIPAA

Lincoln Financial Group Insureds Statement Of Loss

Lincoln Financial Group POA

Metlife Forms

Metlife Guide To Service Provider Payment Home Care

Metlife Guide To Service Provider Payment Informal

Metlife Intake Packet Careworks As Future Provider

Metlife LTC

Metlife Privacy Authorization Release Group-IB

Mutual of Omaha Forms

Mutual of Omaha Authorization for Disclosure Release of Info

Mutual of Omaha Application for Long Term Care Benefits

Mutual of Omaha Disability Form

Northwestern Mutual Forms

Northwestern Mutual Claim Form

New York Life

New York Life insurance claims must be submitted online.

New York Life Forms

New York Life HIPAA

Penn Treaty Forms

Penn Treaty Assignment of Benefits

Penn Treaty Attending Physicians Statement

Penn Treaty Facility Certification of Care For Initial Claim

Penn Treaty HIPPA

Penn Treaty Policyholder Authorization to Release Information

SHIP Forms

SHIP Assignment of Benefits Direction to Pay

SHIP Authorization Form

SHIP Claim Information Package

SHIP HIPAA Claims Processing

SHIP Senior Health Insurance Pennsylvania Claim Form

SHIP Claims Form

State Farm

State Farm insurance claims must be submitted online.

Thrivent Forms

Thrivent Long Term Care

TransAmerica Forms

TransAmerica LTCI Claim

Unum Forms

UNUM Claim Form

Washington National Forms

Washington National Claim Form

Claim Forms Library

Call Us Today!

Contact Family Solutions For Care today at (844) 858-4500 to get the information you need regarding your long-term insurance care or help with a claim.

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