Notice Of Data Event

Group Long Term Disability Claim Form

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Employer Resources
Individuals & Families Resources

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This form needs to be completed by the Employer, Employee, Doctor, and then be sent to PGL.

Group Long Term Disability Claim Form

Complete

Using a blue or black ink pen

Submit

Mail:
Pacific Guardian Life
Attn: Group Claims Department
P.O. Box 14294
Lexington, KY