In order to file your long-term care insurance claim, it is imperative that you use the proper claim form from your carrier. For your convenience, CareWorks Health Services has provided the most recent claim forms from the most popular carriers.

 

Allianz Claim Form

Bankers Life Claim Initiation Forms

Bankers Life Long Term Care Form

CalPERs Agency Provider Form

CalPERs Agency Statement Calpers Appeal Form

CalPERs Assignment of Benefits Independent Provider

CalPERs Assignment of Benefits

CalPERs Assignment of Benefits Independent Provider

CalPERs Assignment of Benefits Service Provider

CalPERs Authorization to Release Individual Personal Representative Form

CalPERs Authorization Disclose Health

CalPERs How to File a Claim

CalPERs Independent Provider Packet

CalPERs Independent Provider Weekly Time Sheet

CalPERs Filing a Claim – What Is Needed?

CalPERs Online Claim Form

CalPERs PHI Form

CalPERs Reconsideration Form

CalPERs

CalPERs Form

CNA Authorization To Release Info Disclosure Form

CNA Claim Form

CNA Claimants Statement

Conseco Claim Form

Long Term Care Insurance Form

Lincoln Financial Group Assignment Of Benefits

Lincoln Fnancial Group Care Provider Assessment

Lincoln Financial Group HIPAA

Lincoln Financial Group Insureds Statement Of Loss

Lincoln Financial Group POA

Metlife Guide To Service Provider Payment Home Care
Metlife Guide To Service Provider Payment Informal
Metlife Intake Packet Careworks As Future Provider
metlife_ltc
Metlife Privacy Authorization Release Group-IB

Mutual of Omaha Authorization for Disclosure Release of Info

Mutual of Omaha Application for Long Term Care Benefits

Mutual of Omaha Disability Form

Northwestern Mutual Claim Form

New York Life HIPAA

Penn Treaty Assignment of Benefits

Penn Treaty Attending Physicians Statement

Penn Treaty Facility Certification of Care For Initial Claim

Penn Treaty HIPAA

Penn Treaty Policyholder Authorizationto Release Information

SHIP Assignment of Benefits Direction to Pay

SHIP Authorization Form

SHIP Claim Information Package

SHIP HIPAA Claims Processing

SHIP Senior Health Insurance Pennsylvania Claim Form

SHIP Claims Form

Thrivent Long Term Care

TransAmerica LTCI Claim

UNUM Claim Form

Washington National Claim Form

Companies that prefer claims to be submitted online include:

Let us help you get your LTC insurance benefits