State Disability Contacts
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| State Disability Tel No: 800-535-2711 Fax No: 800 584-9370 |
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National Benefit Life Insurance Company State Disability Plans One Court Square Long Island City, NY 11120-0001
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Customer Service:
To request a Policy Change: PCR - Policy Change Request Form | |
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Underwriting: To get a DBL quote for groups with 50+ lives: DBLQQ-1 - NY DBL Quick Quote Request Form To get a TDB quote for groups with 25+ lives: TDBQQ-1 - NJ TDB Quick Quote Request Form Greg Ranieri Underwriter Tel No: 718 248-8797 underwriting@nationalbenefitlife.com
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New Business Submissions: To check rates for groups with fewer than 50 lives: DRC - NY DBL Rate Card To apply for NY DBL coverage: A8-906-DBL - DBL Application To apply for NJ TDB coverage: TDB-AP1 - TDB Application DP-1 Application for Approval of Insured Private Plan newbusiness@nationalbenefitlife.com |
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Licensing: To get a W-9: W-9 - Request for Taxpayer Identification and Certification licensing@nationalbenefitlife.com | |
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Premium Remittance: National Benefit Life Insurance Company State Disability Premium P.O. Box 7247-8844 Philadelphia, PA 19170-8844 | |
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Sales and Marketing: Paul Borowiak Regional Manager Tel No: 716 652-4604 Fax No: 716 652-5267 marketing@nationalbenefitlife.com | |
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Claims: Tel No: 800 535-2710 Fax No: 800 584-9303 claims@nationalbenefitlife.com |
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National Benefit Life Insurance Company State Disability Claims PO Box 1946 Long Island City, NY 11101 To get a NY DBL Claim form: DB-450 Notice and Proof of NY DBL Claim To get a NJ TDB Claim form: WDS-1 NJ-TDB Claim Form | |