Disability Disclosure Authorization

We want you to get the disability benefits you deserve.

First, we need your authorization to collect information to support your claim. To do so, it's important that you mail a signed Disclosure Authorization Form to us to begin processing your request for benefits.

Simply follow these two easy steps:

1. Print out the Disclosure Authorization Form below.
   
   Disclosure Authorization* (PDF 25k)
   
   
2. Sign, date, and fax your form to our Intake Service Center at
   1.800.642.8553.
                                                or
   
   Sign, date and mail the Disclosure Authorization Form to the office that manages your claim.

Dallas, TX
CIGNA Group Insurance
P.O. Box 709015
Dallas, TX TX 75370-9015

Glendale, CA
CIGNA Group Insurance
400 N. Brand Blvd., Suite 400
Glendale, CA 91203

Pittsburgh, PA
CIGNA Group Insurance
P.O. Box 22325
Pittsburgh, PA 15219

Eden Prairie, MN
CIGNA Group Insurance
P.O. Box 46357
Eden Prairie, MN 55344

Don't know which office to mail your form to?
Call CIGNA Group Insurance at 1.800.36CIGNA or 1.800.362.4462. A Customer Service Representative will be happy to give you the information you need.