NEARLY A CENTURY OF
BOUTIQUE CLAIMS ADJUDICATION
Group insurance claims for firefighters, EMS providers, Law Enforcement, volunteer groups, nonprofit organizations, & more
With nearly a century of claims experience, Provident Claims Services, Inc., has a dedicated and caring staff who remain committed to timeliness and accuracy while processing your claim. It remains our goal to treat people with the utmost respect and courtesy. If you have any questions or concerns, please contact our office by calling (800) 447-0360, or email your inquiry to claims@providentclaims.com
If filling out one of the fillable and printable PDFs below, the fields of these forms can be completed online but must be printed and signed prior to being returned to the office. For prompt attention, either email the completed claim form and supporting documentation to claims@providentclaims.com or fax to (412) 963-0148.
Accident & Health
First Notice of Claim
DUTY RELATED CANCER BENEFIT
First Notice of Claim
24-Hour AD&D
First Notice of Claim
Group Critical Illness
First Notice of Claim
GROUP TERM LIFE
First Notice of Claim
SPECIAL RISKS
First Notice of Claim
FirePlus P&C Claims Information
Online & Downloadable Claim Form Updates
Accident & Health
First Notice of Claim
DUTY RELATED CANCER BENEFIT
First Notice of Claim
24-Hour AD&D
First Notice of Claim
Group Critical Illness
First Notice of Claim
GROUP TERM LIFE
First Notice of Claim
SPECIAL RISKS
First Notice of Claim
FirePlus P&C Claims Information
Online & Downloadable Claim Form Updates
We’re here to help you file a claim!
Use our Reference Guide to learn how. We try to make it as easy as possible.
Accident & Health - First Notice of Claim Forms
If your Accident & Health policy number begins with PRCO, PRLE, PRNC, PRST, or PRSW, please choose ONE of the following first notice of claim forms to complete:
If you prefer to fill out the above forms via fillable and printable PDF, please email claims@providentclaims.com to request a copy.
If your Provident Accident & Health policy number begins with ESO, please make your selection from the two choices below:
Duty Related Cancer Benefit - First Notice of Claim Form
If your Cancer Benefit policy number begins with PRCA, please use the following first notice of claim form:
24-Hour Accidental Death & Dismemberment - First Notice of Claim Forms
If you are filing a 24-Hour Accidental Death & Dismemberment (24-Hour AD&D) claim and your policy number begins with EXAD, EXLE, EXSW, BADD, or VOLF, please use the following first notice of claim form:
If you are filing a 24-Hour Accidental Death & Dismemberment (24-Hour AD&D) claim and your policy number begins with AK, please use the following first notice of claim form:
If you are filing a 24-Hour Accidental Death & Dismemberment (24-Hour AD&D) claim and your policy number begins with 9907, please use the following first notice of claim form:
Group Critical Illness - First Notice of Claim Form
If you are filing a Group Critical Illness Insurance claim and your policy number begins with CRTI, please use the following first notice of claim form:
Group Term Life - First Notice of Claim Forms
If you are filing a Group Term Life Insurance claim and your policy number begins with G-30175 or G-30176, please use the following first notice of claim form:
If you are filing a Group Term Life Insurance claim for accelerated benefits and your policy number begins with G-30175, please use the following claim form:
If you are filing a Group Life Insurance claim and your policy number begins with AGL, please use the following first notice of claim form:
Special Risks - First Notice of Claim Form
If you are filing a Special Risks accident claim and your policy number begins with BTAB, CAMP, COSC, KAMB, PAYB, SRPO, or SRSW, please use the following first notice of claim form:
FirePlus P&C Claims Information
If you are filing a Property & Casualty claim, please email claims@providentfireplus.com
Online & Downloadable Claim Form Updates
If you are filing a Special Risks accident claim and your policy number begins with BTAB, CAMP, COSC, KAMB, PAYB, or SRPO, please use the following first notice of claim form:
