Fill out the top section and give details about your accident or illness. Your supervisor needs to fill out the middle section, and your doctor will need to fill out the bottom section.

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After you have completed the forms, you can fax it to the Combined Insurance claims department at the number listed on the claim form. You can also contact the Combined Insurance claims department and they will help you file it.

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Contact our office to get the paperwork needed to make a claim.

Contact your area’s Combined Account Executive or our office to get the paperwork needed to make a claim.

Your Vision provider should file a claim for you. However, if you go to a provider that does not file claims for you, contact your vision insurance or our office to begin filing a claim.