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Submit a disability claim

If your employer offers a disability plan through New York Life Group Benefits Solutions, you can file a claim online in just 10-15 minutes. 

Before you begin

Please provide complete and accurate information to avoid processing delays. If you don’t have everything now, fill in as much as you can. 

Required for all claims

  • Basic information: Claimant’s legal name, date of birth, Social Security number, and contact details

  • Claim details: Work schedule, expected claim dates, and relevant facilities’ or providers’ contact info

For specific claim types

  • Maternity: Expected/actual delivery date and type 

  • Injury/Illness: Date of injury or when symptoms began  

  • Surgery: Date and type of surgery

You can also submit your claim via fax or mail. You’ll need to download, print, complete, sign, and mail or fax your claim form. Please print and complete the appropriate disability form listed below: 

 

Mail or fax the completed and signed forms to: 

New York Life Group Benefit Solutions 
Paper Intake Team 
P.O. Box 709015 
Dallas, TX 75370-9015 
Fax: 800-642-8553

After you file your claim 

1. A dedicated Claim Manager will be assigned and may contact you for further details.  
 
2. Once you receive your claim acknowledgement letter, visit myNYLGBS.com to register for an account.  
 
3. Registering gives you instant access to check your claim status, upload documents, and communicate with your Claim Manager.

For questions, call us at  (888) 842-4462 between 7:00 a.m. and 7:00 p.m. central time.

File a disability claim

You can review your answers before submitting your claim in step 12. A case manager may follow up to confirm details or request additional information. 

  1. Personal Information
  2. Employment Information
  3. Work Schedule
  4. Claim Dates
  5. Type of Claim
  6. Claim Details
  7. Facility Information
  8. Provider Information
  9. Disclosure Authorization
  10. Additional Information
  11. Fraud Warning
  12. Summary and Review

Personal information

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First, let's make sure we have the contact information we need.


Submitter personal information


Claimant personal information

If you choose to receive text messages, you agree to receive a one-time text/SMS message as part of the opt-in process. Standard text/SMS rates may apply. Check with your mobile phone carrier.
 

By signing up for email updates, you agree to receive claim alerts via email. If you decide you’d like to stop receiving these updates, you can change your email preference at any point. To learn more about how we keep your information safe, read our privacy practices.

 

Employment information

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Work schedule

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Fixed Weekly Schedule


Standard Weekly Schedule


Week One


Week Two


Week Three


Week Four

Claim dates

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Enter the dates you think your time off will start and end. If you're not sure of the exact dates, you can do your best to estimate and update them later.

The last day at work before your claim begins.

The first day you miss work due to your claim.

The day before you return to work due to your claim or the end of the estimated time you need to recover from childbirth.


Example: Corey's claim dates

Corey is filing a disability claim to recover from an accident. The last day they worked was Friday, April 28, and the first day they missed work was Monday, May 1. Corey thinks they will go back to work August 1 but isn't sure. Based on this information, here is how Corey filled in their claim dates:

  • Last day worked: 04/28/2023
  • Claim start date: 05/01/2023 (Full day)
  • Claim end date: 07/31/2023 (Full day)
  • Return to work date: 08/01/2023

Type of claim

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Please select the type of claim you are filing. Keep in mind, when you have a life event, you only need to file one claim with us; if you’re eligible for other benefits, we’ll apply those during our claim review.

Illness

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Dealing with an injury or illness can be challenging. Please share more details so we can better assist you.

Accident or injury

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Dealing with an accident or injury can be challenging. Please share more details so we can better assist you.

Maternity

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Tell us a bit more about your pregnancy.

Surgery

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Tell us a bit more about your surgery.

Facility information

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If you received care at a hospital or clinic for your claim, please share more details about your visit.

Provider information

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Just a couple more steps to go. As we review your claim, we will need to reach out to any healthcare providers (such as physician, surgeon, etc.) you saw as part of this claim. To help this process move smoothly, please share their contact information below.


Provider One


Provider Two (optional)

Disclosure authorization

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Sometimes we need to reach out to your healthcare provider(s) to gather additional information specific to your claim. Please see below for more on why this is important.
 

Disclosure Authorization


NOTE: This authorization is designed to comply with the Health Insurance Portability and Accountability Act of 1996 ("HIPAA") and relates to information necessary to administer benefits and services under Employer’s employee health and welfare plan(s) ("the Plan") and statutory and/or private leave of absence or job accommodation programs. "Employer” is defined to mean your employer, or your family member’s employer to the extent benefits, services, or leave are being sought under your family member’s employer’s Plan. You are not required to sign the authorization, but if you do not, the Plan, insurers or other providers may not be able to process your (or your family member’s) request for benefits or services under the Plan or statutory and/or private leave of absence or job accommodation programs.

 

AUTHORIZATION 

I authorize any physician, medical professional or other health care provider, hospital or other medical facility; pharmacy; health plan; other medically related entity; rehabilitation professional; vocational evaluator; employee assistance plan; insurance company, reinsurer, health maintenance organization, third party administrator, broker or other insurance service provider, or similar entity; the Medical Information Bureau; the Association of Life Insurance Companies, which operates the Health Claims Index and the Disability Income Record System; government organization or agency, including the Social Security Administration; social security disability advocate or representative; financial institution, accountant or tax preparer; consumer reporting agency; and employer or group policyholder that has information about my health, prescriptions, financial, earnings or employment history, or other insurance claims and benefits, to provide access to or copies of this information (whether by written, telephonic or electronic means) to Life Insurance Company of North America; New York Life Group Insurance Company of NY (Life Insurance Company of North America and New York Life Group Insurance Company of NY shall be collectively referred to as "Insurance Company"); and any other individual or entity (including nonaffiliated third parties) that provides services to or insurance benefits on behalf of the Plan and/or Employer’s statutory and/or private leave of absence or job accommodation programs. If I am also covered by Cigna Health and Life Insurance Company or its affiliates (“Cigna”), I authorize Insurance Company to disclose the health and other information described above to Cigna to assist me with my health coverage and to provide its services and benefits. This information will be shared to coordinate benefits and provide other services to you. 

 

Information about my health may relate to any disorder of the immune system including but not limited to HIV and AIDS; use of drugs or alcohol; and mental and physical history, condition, advice or treatment, but does not include psychotherapy notes or genetic information. 

 

I agree and understand that any information obtained with this authorization may be used and disclosed for the following purposes: 1) evaluating and administering coverage, including any claim for benefits, or otherwise providing services related to or on behalf of the Plan; 2) evaluating and administering services related to Employer’s statutory and/or private leave of absence or job accommodation programs; 3) determining my eligibility for any governmental benefits similar to or that coordinate with benefits available to me under the Plan and assisting me in applying for such benefits; and 4) evaluating and administering benefits or services under any other plans sponsored by or offered through Employer such as health management, disease management, wellness, or employee/member assistance programs. 

 

I understand that the information disclosed under this authorization is subject to redisclosure and may no longer be protected by HIPAA or other federal regulations governing the privacy of health information, although it may continue to be protected by other applicable privacy laws  and regulations. I further understand that if any information is used for services relating to Employer’s leave of absence or job accommodation programs, that information may be disclosed to Employer at any time. Additionally, I understand that information may be disclosed to the employee who elected my coverage or submitted a claim for benefits under my coverage, or requested leave. 

 

This authorization shall be valid for 12 months or the duration of my claim for insurance benefits, whichever is longer. I also understand that Insurance Company will maintain a copy of this authorization, and that I am entitled to a copy of this authorization and a photographic or electronic copy of it is as valid as the original. 

 

I understand that I do not have to give this authorization. If I choose not to give the authorization - or if I later revoke - I understand that the Plan, insurers, or other providers of services or benefits related to the Plan or Employer’s statutory and/or private leave of absence or job accommodation programs who rely on this authorization may not be able to evaluate or administer any request for benefits, coverage or services and that any request for benefits, coverage or services may be denied as a result. I may revoke this authorization by sending written notice to the Claim Manager handling the claim. 

 

924563  Rev. 03/2021

Additional information

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You're almost finished filing your claim. Before moving forward, is there any other information you'd like to share with us?

Fraud warning

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Before submitting your claim, please take a moment to review the information below.


Any person who, knowingly and with intent to defraud any insurance company or other person: (1) Files an application for insurance or statement of claim containing any materially false information; or (2) conceals for the purpose of misleading, information concerning any material fact thereto, commits a fraudulent insurance act.

For residents of the District of Columbia and the following states, please see below: California, Colorado, District of Columbia, Florida, Kentucky, Louisiana, Maryland, Minnesota, New Jersey, New York, Oregon, Pennsylvania, Rhode Island, Tennessee, Texas, and Virginia.

 

Click "Submit" on the next page if you have read the fraud language and wish to submit your claim.

 

IMPORTANT CLAIM NOTICE

California Residents: For your protection California law requires the following to appear on this form: Any person who knowingly presents false or fraudulent information to obtain or amend insurance coverage or to make a claim for the payment of a loss is guility of a crime and may be subject to fines and confinement in state prison.

Colorado Residents: It is unlawful to knowingly provide false, incomplete, or misleading facts or information to an insurance company for the purpose of defrauding or attempting to defraud the company. Penalties may include imprisonment, fines, denial of insurance, and civil damages. Any insurance company or agent of an insurance company who knowingly provides false, incomplete or misleading facts or information to a policyholder or claimant for the purpose of defrauding or attempting to defraud the policyholder or claimant with regard to a settlement or award payable from insurance proceeds shall be reported to the Colorado division of insurance within the department of regulatory agencies.

District of Columbia Residents: WARNING: It is a crime to provide false or misleading information to an insurer for the purpose of defrauding the insurer or any other person. Penalties include imprisonment and/or fines. In addition, an insurer may deny insurance benefits if false information materially related to a claim was provided by the applicant.

Florida Residents: Any person who knowingly and with intent to injure, defraud, or deceive any insurer files a statement of claim or an application containing any false, incomplete, or misleading information is guilty of a felony of the third degree.

Kentucky Residents: Any person who knowingly and with intent to defraud any insurance company or other person files a statement of claim containing any materially false information or conceals, for the purpose of misleading, information concerning any fact material thereto commits a fraudulent insurance act, which is a crime.

 

Louisiana Residents: Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or knowingly presents false information in an application for insurance is guilty of a crime and may be subject to fines and confinement in prison.

 

Maryland Residents: Any person who knowingly and willfully presents a false or fraudulent claim for payment of a loss or benefit or who knowingly and willfully presents false information in an application for insurance is guilty of a crime and may be subject to fines and confinement in prison.

Minnesota Residents: A person who files a claim with intent to defraud or helps commit a fraud against an insurer is guilty of a crime.

New Jersey Residents: Any person who knowingly files a statement of claim containing any false or misleading information is subject to criminal and civil penalties.

New York Residents: Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claim containing any materially false information, or conceals, for the purpose of misleading, information concerning any fact material thereto, commits a fraudulent insurance act, which is a crime and shall also be subject to a civil penalty not to exceed $5,000 and the stated value of the claim for each such violation.

Oregon Residents: Any person who knowingly and with intent to defraud any insurance company or other person: (1) files an application for insurance or statement of claim containing any materially false information; or (2) conceals, for the purpose of misleading, information concerning any material fact, may have committed a fraudulent insurance act.

Pennsylvania Residents: Any person who, knowingly and with intent to defraud any insurance company or other person, files an application for insurance or statement of claim containing any materially false information, or conceals for the purpose of misleading, information concerning any fact material thereto, commits a fraudulent insurance act, which is a crime and subjects such person to criminal and civil penalties.

Rhode Island Residents: Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit, or knowingly presents false information in an application for insurance, is guilty of a crime and may be subject to fines and confinement in prison.

Tennessee Residents: It is a crime to knowingly provide false, incomplete, or misleading information to an insurance company for the purpose of defrauding the company. Penalties include imprisonment, fines, and denial of insurance benefits.

Texas Residents: Any person who knowingly presents a false or fraudulent claim for the payment of a loss is guilty of a crime and may be subject to fines and confinement in state prison.

Virginia Residents: Any person who, with the intent to defraud or knowing that he is facilitating a fraud against an insurer, submits an application or files a claim containing a false or deceptive statement may have violated state law.

Have a question? Call 800-362-4462 between 7:00 a.m. and 7:00 p.m. Central Time

Summary and review

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Let's make sure we captured your information correctly. Please take a moment to review and edit, as needed.

New York Life Group Benefit Solutions products and services are provided by Life Insurance Company of North America, New York Life Group Insurance Company of NY and New York Life Insurance and Annuity Corporation, subsidiaries of New York Life Insurance Company.

Life Insurance Company of North America is not licensed in New York and does not conduct insurance business in New York.