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Select material to view - UNUM Forms Management System ... 2026

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The document is a Long Term Care Claim Form provided by Unum Group, detailing the process for policyholders to file claims for long-term care benefits. It outlines the necessary steps, including completing various sections of the form, submitting required documentation, and understanding eligibility based on Activities of Daily Living (ADLs) and cognitive impairments. The form also includes fraud warnings specific to different states and requires signatures from both the claimant and attending physician.

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Click ‘Get Form’ to open it in the editor.
Begin by entering your personal information in the designated fields, including your full name, mailing address, and contact numbers.
Indicate the medical condition causing your need for assistance with Activities of Daily Living (ADLs) and provide details about your care needs.
Complete the grid regarding assistance needed for each ADL, marking 'Yes' or 'No' and providing dates when help was first required.
Fill out the section regarding supervision needs if applicable, detailing any cognitive impairments and their impact on your daily life.
List all care providers involved in your treatment, ensuring to include their contact information and the duration of care.
Review all entered information for accuracy before submitting the form through our platform’s submission options.

Start using our platform today to streamline your claims process effortlessly!

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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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