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DISABILITY OR WAIVER OF PREMIUM CLAIM NOTIFICATION FORM

The onset of a disability can be a difficult experience. The focus should be on your health, not paperwork. That's why we've made it easy for you to file a claim.

Take this first step

  • Complete the Online Notification of Disability or Waiver of Premium Claim below and click submit.

If you have any questions regarding your claim

  • Call us toll-free at 800-487-1485. Select option 4. Then select option 4.
  • We're here for you Monday through Friday 8:00 a.m. to 4:40 p.m. ET.
Claim Form
(* Required Information)

Without the following information, we can only respond to the address of record for the policy number provided below.

Name*
Relationship to Insured
Street Address*
City*
State*
ZIP Code* (Must be 5 or 9 digits)
Daytime Phone Number*
Evening Phone Number
Email Address
How would you like for us to respond to you?*
Email Telephone U.S. Mail

Insured's Personal Information:

Name*
Street Address*
City*
State*
ZIP Code* (Must be 5 or 9 digits)
Policy Number(s)* (separated by commas)
Date of Birth
(mm/dd/yyyy)
Date of Disability*
(mm/dd/yyyy)
Cause of Disability
Hello future.
Lincoln Financial Group is the marketing name for Lincoln National Corporation and insurance
company affiliates, including The Lincoln National Life Insurance Company, Fort Wayne, IN,
and in New York, Lincoln Life & Annuity Company of New York, Syracuse, NY. Variable products
distributed by broker/dealer-affiliate Lincoln Financial Distributors, Inc., Radnor, PA. Securities
and investment advisory services offered through other affiliates. Explore Lincoln.



LCN-876666-031114
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Some Lincoln Financial websites are scheduled for maintenance starting Saturday, April 18, 2015 at 7:00 AM ET, and are scheduled to conclude on Sunday, April 19, 2015 at 9:00 AM ET. During this time period users may experience a decrease in performance capabilities. We apologize for any inconvenience.
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