Submit a request to initiate a claim.
One of our goals at Benefits Planning Corporation is to provide superior service and administrative assistance. We strive to ease the burden of filing a claim during what could be a difficult time for you and your family.
If you wish to file claim through our website, please select the insurance company you are filing a short-term disability claim for below. Each tab will provide instructions on how to file that claim.
If you are unsure which tab to select or which policy(ies) you have with us, please call our claims specialists at 631-991-6050 and our team will be happy to assist you.
**Please note, as the administrator of these plans, we can only assist you with the process of filing a claim. We are not the insurance company and do not underwrite any claim that is filed. We cannot approve or deny benefits for a submitted claim and do not pay claim benefits.
Aflac - Initial Claim
Aflac Initial Short Term Disability Form
Aflac’s Initial Claim Forms will be used for starting a new claim in the case of a disability due to sickness, injury, or pregnancy.
- Step 1. Complete the Employee Section: Please fill out the “employee” portion of the claim forms accurately and completely.
- Step 2. Physician’s Section: Provide the forms to your physician to complete the “physician” section. Please ensure your physician includes the ICD code and their Tax ID number, as these are the most common reasons for claim delays.
- Step 3. Return Completed Forms: Once both sections are complete, please return the forms to our office via one of the following methods. Do NOT send directly to Aflac.
- Fax: 631-991-6050
- Email: claims@mybpc.com
- Mail: Benefits Planning Corporation Attn: Claims Dept. 150 Motor Parkway Suite 125 Hauppauge, NY 11788
- Step 4. Set up Direct Billing with Aflac: To prevent a lapse in coverage, it is your responsibility to contact Aflac at 800-366-3436 to set up direct billing for your premium payments while you are out on disability and not receiving payroll deductions.
- Step 5. Monitor Deductions Upon Return to Work: When you return to work, please verify that your Aflac deductions have automatically restarted. If you do not see the Aflac deduction on your paycheck, contact us immediately at 631-991-6050.
Claim Form
Aflac - Continuing Claim
Aflac Continuing Short Term Disability Form
Aflac’s Continuing Claim Forms will be used for continuing an already existing claim in the case of a disability due to sickness, injury, or pregnancy that is extended past the date on your initial claim.
- Step 1. Complete the Employee Section: Please fill out the “employee” portion of the claim forms accurately and completely.
- Step 2. Physician’s Section: Provide the forms to your physician to complete the “physician” section. Please ensure your physician includes the ICD code and their Tax ID number, as these are the most common reasons for claim delays.
- Step 3. Return Completed Forms: Once both sections are complete, please return the forms to our office via one of the following methods. Do NOT send directly to Aflac.
- Fax: 631-991-6050
- Email: claims@mybpc.com
- Mail: Benefits Planning Corporation Attn: Claims Dept. 150 Motor Parkway Suite 125 Hauppauge, NY 11788
- Step 4. Set up Direct Billing with Aflac: To prevent a lapse in coverage, it is your responsibility to contact Aflac at 800-366-3436 to set up direct billing for your premium payments while you are out on disability and not receiving payroll deductions.
- Step 5. Monitor Deductions Upon Return to Work: When you return to work, please verify that your Aflac deductions have automatically restarted. If you do not see the Aflac deduction on your paycheck, contact us immediately at 631-991-6050.
Click the button below to download the form to file a claim.
Claim Form
Life Insurance Company of Boston & New York (Boston Mutual)
Life Insurance Company of Boston & New York (Boston Mutual) Short Term Disability Forms
Call Life Insurance Company of Boston & New York directly at 877-274-1958 to start the claim process. They will then send you the appropriate claim forms to you.
Paul Revere / Colonial - Initial Claim
Paul Revere / Colonial Initial Short Term Disability Forms
Colonial’s Initial Claim Forms will be used for starting a new claim in the case of a disability due to sickness, injury, or pregnancy.
- Step 1: Download claim forms by clicking the link below or simply call us at 631-991-6050 so we can email, fax, or mail them to you.
- Step 2: Complete the Employee section labeled “Section 1 – Claiment Section”, you will then have your Doctor complete their section labeled “Section 3 – Physicians Statement”
- Step 3. Return Completed Forms: Once both sections are complete, please return the forms to our office via one of the following methods.
- Fax: 631-991-6050
- Email: claims@mybpc.com
- Mail: Benefits Planning Corporation Attn: Claims Dept. 150 Motor Parkway Suite 125 Hauppauge, NY 11788
- Step 4. Set up Direct Billing with Colonial: To prevent a lapse in coverage, it is your responsibility to contact Aflac at 800-325-4366 to set up direct billing for your premium payments while you are out on disability and not receiving payroll deductions.
- Step 5. Monitor Deductions Upon Return to Work: When you return to work, please verify that your Colonial deductions have automatically restarted. If you do not see the Colonial deduction on your paycheck, contact us immediately at 631-991-6050.
Choose from the buttons below to download the form to file a claim.
Claim FormPregnancy Claim Form
Paul Revere / Colonial - Continuing Claim
Paul Revere / Colonial Continuing Short Term Disability Forms
Colonial’s Continuing Claim Forms will be used for continuing an already existing claim in the case of a disability due to sickness, injury, or pregnancy that is extended past the date on your initial claim.
- Step 1: Download claim forms by clicking the link below or simply call us at 631-991-6050 so we can email, fax, or mail them to you.
- Step 2: Complete the Employee section labeled “Section 1 – Claiment Section”, you will then have your Doctor complete their section labeled “Section 3 – Physicians Statement”
- Step 3. Return Completed Forms: Once both sections are complete, please return the forms to our office via one of the following methods.
- Fax: 631-991-6050
- Email: claims@mybpc.com
- Mail: Benefits Planning Corporation Attn: Claims Dept. 150 Motor Parkway Suite 125 Hauppauge, NY 11788
- Step 4. Set up Direct Billing with Colonial: To prevent a lapse in coverage, it is your responsibility to contact Aflac at 800-325-4366 to set up direct billing for your premium payments while you are out on disability and not receiving payroll deductions.
- Step 5. Monitor Deductions Upon Return to Work: When you return to work, please verify that your Colonial deductions have automatically restarted. If you do not see the Colonial deduction on your paycheck, contact us immediately at 631-991-6050.
Click the button below to download the form to file a claim.
Claim Form
Trustmark Initial Claim
Trustmark Short Term Disability Forms
Trustmark Initial Claim Forms will be used for starting a new claim in the case of a disability due to sickness, injury (outside of work), or pregnancy.
- Step 1: Download claim forms by clicking the link below or simply call us at 631-991-6050 so we can email, fax, or mail them to you.
- Step 2: Read page 2 of the claim forms for instructions on what sections, supporting documents and information are required to complete.
- Step 3: Return Completed Forms: Once both sections are complete, please return the forms directly to Trustmark via one of the following methods.
- Fax: 508-853-2757
- Email: DICIClaimsVB@trustmarkbenefits.com
Choose from the buttons below to download the form to file a claim.
Claim Form
Trustmark Continuing Claim
Trustmark Short Term Disability Forms
Trustmark’s Continuing Claim Forms will be used for continuing an already existing claim in the case of a disability due to sickness, injury (outside of work), or pregnancy that is extended past the date on your initial claim.
- Step 1: Download claim forms by clicking the link below or simply call us at 631-991-6050 so we can email, fax, or mail them to you.
- Step 2: Read page 2 of the claim forms for instructions on what sections, supporting documents and information are required to complete.
- Step 3: Return Completed Forms: Once both sections are complete, please return the forms directly to Trustmark via one of the following methods.
- Fax: 508-853-2757
- Email: DICIClaimsVB@trustmarkbenefits.com
Click the button below to download the form to file a claim.
Claim Form
UNUM - Initial Claim
UNUM Initial Short Term Disability Forms
UNUM’s Initial Claim Forms will be used for starting a new claim in the case of a disability due to sickness, injury, or pregnancy.
- Step 1: Download claim forms by clicking the link below or simply call us at 631-991-6050 so we can email, fax, or mail them to you.
- Step 2: Complete the Employee section labeled “Section 1 – Claiment Section”, then you will have your Doctor complete their section labeled “Section 3 – Physicians Statement”
- Step 3. Return Completed Forms: Once both sections are complete, please return the forms to our office via one of the following methods.
- Fax: 631-991-6050
- Email: claims@mybpc.com
- Mail: Benefits Planning Corporation Attn: Claims Dept. 150 Motor Parkway Suite 125 Hauppauge, NY 11788
- Step 4. Set up Direct Billing with UNUM: To prevent a lapse in coverage, it is your responsibility to contact UNUM at 800-375-8226 to set up direct billing for your premium payments while you are out on disability and not receiving payroll deductions.
- Step 5. Monitor Deductions Upon Return to Work: When you return to work, please verify that your UNUM deductions have automatically restarted. If you do not see the UNUM deduction on your paycheck, contact us immediately at 631-991-6050.
Click the button below to download the form to file a claim.
Claim Form
UNUM - Continuing Claim
UNUM Continuing Short Term Disability Forms
UNUM’s Continuing Claim Forms will be used for continuing a claim in the case of a disability due to sickness, injury, or pregnancy.
- Step 1: Download claim forms by clicking the link below or simply call us at 631-991-6050 so we can email, fax, or mail them to you.
- Step 2: Complete the Employee section labeled “Section 1 – Claiment Section”, then you will have your Doctor complete their section labeled “Section 3 – Physicians Statement”
- Step 3. Return Completed Forms: Once both sections are complete, please return the forms to our office via one of the following methods.
- Fax: 631-991-6050
- Email: claims@mybpc.com
- Mail: Benefits Planning Corporation Attn: Claims Dept. 150 Motor Parkway Suite 125 Hauppauge, NY 11788
- Step 4. Set up Direct Billing with UNUM: To prevent a lapse in coverage, it is your responsibility to contact UNUM at 800-375-8226 to set up direct billing for your premium payments while you are out on disability and not receiving payroll deductions.
- Step 5. Monitor Deductions Upon Return to Work: When you return to work, please verify that your UNUM deductions have automatically restarted. If you do not see the UNUM deduction on your paycheck, contact us immediately at 631-991-6050.
Click the button below to download the form to file a claim.
Claim Form
