File a Debt Protection Claim

Please Note: This form should only be completed if you have disability or involuntary unemployment protection on your loan and would like to submit a claim.

If you have any questions in regard to an ongoing claim, please contact the Member Advocates department at 260-484-2102 extenstion 5107, or reach out to Securian directly.

Please complete the following information for the insured party:

Account Number *

Full Name *

Date of Birth *

Address *

Email Address *

Phone Number *

Date of Loss (first date you were off work due to claim) *

What caused the disability or unemployment? *

Preferred contact method & time *

Agreements

Please be aware that once the claim is submitted, there will be multiple forms that you or your physician may need to fill out that Securian will send to you. *

I understand

Securian may also mail/email out requests for any medical supporting documentation. You can send or fax this information to the contact information on the communication you receive, or, stop into a branch for us to submit on your behalf.

I understand

If you have any questions in regard to your claim, please contact the Member Advocates department at 260-484-2102 ext 5107, or reach out to Securian directly (Please note you can only reach out to Securian directly once your claim has been started).

Thank You