Claim forms are provided in the “Welcome Packet” and may be downloaded from www.selmantricareresource.com. Claim forms can also be requested by contacting Customer Service.

This claim form is for Hartford Supplemental policies.

This claim form (TFLIC Long) is for TFLIC Retail policies when the DOS occurred during the first six months of coverage.

This claim form (TFLIC Short) is for TFLIC Corporate policies (any DOS) and also for TFLIC Retail policies when the DOS was during or after the seventh month of coverage.