Critical Illness ClaimIllness Claim • May 5th, 2021
Please indicate below for optional services you desire. Any marks used (check mark, X, initials, etc.) will be considered as your authorization and will be processed as if they were selected.
ContractIllness Claim • November 6th, 2013
Critical Illness Claim FAX this form: 1-800-880-9325FAX this direction Or mail: P.O. Box 100195, Columbia SC 29202 From: Number of pages: File Your Claim Online u Simply log into your account at Coloniallife.com and click on “File an Online Claim”.u As an added convenience, you may also select Direct Deposit when filing online.u Not a member? Log onto Coloniallife.com and click on “Register” then “Join the Policyholder Website” to set up your account. Optional Service Release Agreement Please indicate below for optional services you desire. Any marks used (check mark, X, initials, etc.) will be considered as your authorization and will be processed as if they were selected.I authorize Colonial Life to facilitate processing this claim by releasing its details to the following individual inquiring on my behalf.Note: Leave blank if you do not want anyone accessing your claim information. Sales representative Employer Spouse, family member or significant other Name: I want Colonial Life to
