Services for Employers


Our knowledgeable Claim Services staff is committed to providing you with a superior customer experience. At Life Insurance Company of Boston & New York, our insureds and clients are our priority.

For your convenience, our claim forms are available below.

If you are unable to locate what you need, please call our Claim Services department at 877.212.2950 and we’ll be happy to assist you.

If you are an employer needing forms to file a claim for group life and/or disability, or a third party administrator who administers group benefits, please select from the following list of forms.

In addition to downloading your claim form, you MUST also download the appropriate HIPAA-compliant Authorization form by selecting your appropriate state. If your state is not listed – Select standard HIPAA Authorization Form.

You must review and print our Notice of Information Privacy Practices for your records.

All of our forms open with Adobe Acrobat Reader. (Get Acrobat for Free by clicking here.)

Claim Forms

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Disability / Waiver of Premium

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