Claims Initiation for an Employee
Short Term and Long term Disability Claims
• Complete and forward the Claimant's Statement to Fenchurch General Insurance Company as soon as practicable.
• Complete Section 1 of the Attending Physicians Report, take this to your physician and ask him to complete Section 2.
• Forward the completed Attending Physician's report to Fenchurch as soon as practicable.
Forms
• Attending Physicians Report
• Authorization for Release of Information
• Claimants Statement
• Direct Deposit Authorization
• Supplemental Medical Information Request
Guide
Appeals
Should you wish to initiate the appeal process related to the decision of your claim, please complete the following documents and submit via fax or email.
• Employee Appeal Statement
• Supplemental Medical Information Appeal Request