DISABILITY INSURANCE CLAIM FORM - Companion Life 2025

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BENEFITS Employees may choose one of 23 weekly benefit payments, from $150 to $1,250, not to exceed 662/3 percent of basic weekly earnings. All plans include a $10,000 Accidental Death and Dismemberment (ADD) benefit for each insured employee.
APPEALS AND GRIEVANCES: You must file your grievance within one year. Member submitted claims must be received within 365 days from the date of service; however there are some client, state and federal exceptions that may allow more or less days.
Companion claim means a separate claim for each named defendant that is covered under the policy, whether or not they are the named insured on the policy or covered employees or agents of a corporation, association or trust.
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