Boston Mutual Life Insurance Company
Services & Forms – Individuals

Welcome to the Boston Mutual Life Insurance Company forms page, which provides you all of our Claim and Service forms in one convenient location.

Not sure which form you may need? Click here for our customer service and claims frequently asked questions (FAQs).

Please select the form that best meets your needs. All of our forms open with Adobe Acrobat Reader. (Get Acrobat for Free by clicking here.)

Your completed forms should be mailed or faxed to us as directed on each form.

Our knowledgeable Claim Services staff is committed to providing you with a superior customer experience. At Boston Mutual Life Insurance Company, our insureds and clients are our priority.

For your convenience, our claim forms are available below.

If you are unable to locate what you need, please call our Claim Services department at 877.212.2950 and we’ll be happy to assist you.

Please select and download the correct claim form based on the type of coverage you have with us from the forms shown below.

In addition to downloading your claim form, you MUST also download the appropriate HIPAA-compliant Authorization form by selecting your appropriate state. If your state is not listed – Select standard HIPAA Authorization Form.

Please print the claim form and the HIPAA authorization and follow the instructions provided on the claim form.

Claim Forms

Life Insurance

Accident Insurance

Critical Illness Insurance

Disability Insurance

If you are unsure of the specific Disability Income / Waiver form you need and do not have your policy number available, please contact Claim Services at 877.212.2950.


Policy Change Forms

Request for Funds Forms

Before you submit a request for funds, please call our client service line at 877.624.2249 to verify the available funds on your policy. To avoid any delay in processing your request, it is important that you take the time to review the information and instructions on the form, and to fill out the form completely, including the bankruptcy section and all required signatures.