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Click ‘Get Form’ to open the unum long term care form in the editor.
Begin by filling out your personal information in the 'Tell Us Who You Are' section. Include your full name, mailing address, contact number, date of birth, and policy number.
In the 'Tell Us Why You Are Filing a Claim' section, clearly describe the medical condition(s) that necessitate assistance with Activities of Daily Living (ADLs) or supervision due to cognitive impairment.
Proceed to the 'Tell Us About ADLs' section. Check all applicable ADLs where you require assistance, such as bathing, dressing, toileting, transferring, continence, eating, and ambulating/mobility.
Complete the 'Tell Us About Your Need for Supervision' section by indicating if you have experienced a loss in intellectual capacity and specify why supervision is needed.
Fill out your current living situation under 'Tell Us Where You Are Currently Living', providing details if you reside in a care facility or other location.
Identify any additional care providers involved in your treatment in the relevant sections and ensure all required signatures are completed before submission.

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Versions	Form popularity	Fillable & printable
2021	4.9 Satisfied (58 Votes)
2020	4.8 Satisfied (45 Votes)
2015	4.3 Satisfied (91 Votes)
2014	4 Satisfied (23 Votes)

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