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LONG-TERM CARE NOTIFICATION FORM

The need for long-term care and support services can be overwhelming. We want to help reduce the challenges. That's why we've made it easy for you to file a claim.

Take this first step

  • Complete the Online Notification of for a Long-Term Care Claim below and click submit.

Need help?

  • Call us toll-free at 800-487-1485. Select option 4. Then select option 3.
  • 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)
Type of Benefit Claim*
Nursing Home Admission Home Care
Adult Day Care Respite Care
Date of Onset*
(mm/dd/yyyy)
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.



LCN-876666-031114