Your Guide to Filing a Long Term Disability (LTD) Claim

We recognize how important it is for you to begin receiving the Long Term Disability (LTD) benefits to which you may be entitled. HSAC would like to make this process as easy as possible for you by providing all the forms and information you will need to initiate an LTD claim.

To ensure this process goes smoothly, it is important you respond to all questions fully and accurately, and send the forms back to the Guardian as soon as possible -- you should not wait to file a claim until the elimination period has passed. The elimination period is the period of time between the onset of a disability and the time you are eligible for benefits.

How to Complete the Student Disability Claim Form

Please follow the instructions outlined below:

  • Section 1: Student Section – This section should be completed by the student (the claimant).
  • Section 2: Planholder Statement – This section should be provided to and completed in full by the Director of Student Services (Robin Frank).
  • Section 3: Attending Physician’s Statement – You (the claimant) should complete the authorization section. The Attending Physician section should be provided to and completed by the physician who first treated you at the time you stopped attending classes on full time basis.

How to Submit Your Claim

After all sections of the form have been completed, you will need to submit it along with any supporting information or documentation to the following address:

Group LTD Claims
PO Box 26025
Lehigh Valley PA 18002-6025


Via our secure email site at:
When you go to the site, click Secure Channel and select

If you have any questions while completing these forms or would like personal assistance in the completion and submission of your claim, please feel free to contact your servicing agent HSAC at 1-888-978-8355 for assistance. Once the claim information is received, you and your school will be notified of receipt via a formal acknowledgement letter.

Fraud Warning Statement:

Any person who knowingly, and with intent to defraud any insurance company or other person, files an application of insurance or statement of claim containing any materially false information or conceals, for the purpose of misleading, information concerning any fact material thereto, may be guilty of a fraudulent insurance act, which may be a crime, and may also be subject to civil penalties.

Your group disability policy has an important conversion feature that will guarantee you access to Non-Cancelable Own-Occupation disability insurance on a guarantee issue basis. We strongly recommend contacting us for additional information upon graduation.