Services for You and Your Family

Welcome to the Life Insurance Company of Boston & New York forms page, which provides you all of our Claim and Service forms in one convenient location.

Please select the form that best meets your needs. All of our forms open with Adobe Acrobat Reader. (Get Acrobat for Free by clicking here.)

Your completed forms should be mailed or faxed to us as directed on each form.

Claim Forms

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 us at 877.274.1958 and we’ll be happy to assist you.

Please select and download the correct claim form based on the type of coverage you have with us from the forms shown below.

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.

Please print the claim form and the HIPAA authorization and follow the instructions provided on the claim form.

Life Insurance

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Accident Insurance

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Disability / Waiver of Premium

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Specified Disease

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Policy Change Forms

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Request for Funds Forms

Before you submit a request for funds, please call our client service line at 800.645.2317 to verify the available funds on your policy. To avoid any delay in processing your request, it is important that you take the time to review the information and instructions on the form, and to fill out the form completely, including the bankruptcy section and all required signatures.

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