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Get Hartford Life And Accident Insurance Company Living Benefit Option Form

(Claim Form) for your accident policy . Please forward claims and questions to the following address: Fringe Benefit Coordinators, Inc. P. O. Box 5249, Gainesville, FL 32627-5249 Toll Free Number (800) 654-1452 Fax Number (352) 372-9805 Step 1 - Submit a completed Notice of Claim (claim form) to our office either by fax or mail The Policyholder s School Official/Trainer (not the Parent, Claimant or Agent) should: In the Policyholder Certification section of the form, fully answer each q.

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