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It is our goal to streamline and expedite the claim process.

If you have any questions, call us toll free Monday through Thursday between 8:00 a.m. and 6:00 p.m. ET and Fridays 8:00 a.m. and 5:30 p.m. ET at 800 487-1485 and select option 4.

Contact Information
(* = required)

Information About You:

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:
E-mail 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)

Are you aware of any other policies or annuities that include the deceased — as owner, insured, annuitant or payer — that were issued by any of the following companies?

  • The Lincoln National Life Insurance Company
  • Lincoln Life and Annuity Company of New York
  • First Penn-Pacific Life Insurance Company
Yes    No

If YES, please provide details including policy, contract and account numbers.

Date of Birth:
Type of Benefit Claim:*
Nursing Home Admission Home Care
Adult Day Care Respite Care
Date of Onset* :
Cause of Claim* : (description of illness or injury)
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.