Forms
Field Referral Form
Field Visit Request Form for Printing and Faxing
Fax to (860)769-6981
Field Visit Request.doc
Microsoft Word document [54.0 KB]
Fax to (860)769-6981
Field Visit Request.doc
Microsoft Word document [54.0 KB]
Report a Claim
To start the claims process, we will need the following information:
- Policyholder information: Name of insured, address, phone number, e-mail and policy number
- Date of Disability: Date your disability started
- Employer information: Employer name address and contact information if your policy is through your employer
Please send your claims information to:
Disability Insurance Specialists, LLC
PO Box 25
Bloomfield, CT 06002
Fax: 860 243-6562
E-mail: postmaster@dispec.com
To go to our secure file transfer portal click this link: