Unum long term care claim form 2026

1. Click ‘Get Form’ to open the unum long term care claim form in the editor.
2. Begin with Section 1, providing general information such as the employer/group policyholder name, your name, and relationship to the claimant. Ensure all fields are filled accurately.
3. Move to Section 2 and enter details about your primary care physician, including their name, address, and contact information. If applicable, list other physicians involved in your care.
4. In Section 3, provide information about any hospital or facility stays related to your claim. Include names, addresses, dates of admission and discharge, and reasons for admission.
5. Complete Section 4 by detailing who provided assistance during your loss of ADLs or cognitive impairment. Specify the type of care received and frequency.
6. Finally, ensure Section 5 is completed with the Authorization to Release Information signed by you or a legal representative. This is crucial for processing your claim.

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