PROVIDENT


Insurance Claims for Emergency Service Workers

With more than 85 years of emergency service experience, Provident has dedicated and caring claims 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. Please call our office toll-free at 800-447-0360 to speak to a claim representative with any questions.

Forms

How Do I File a Claim?

Accident & Health First Notice of Claim Forms
If you are filing an Accident & Health claim, please use the appropriate form from the options below.  If you have any questions or concerns regarding the correct form to use, please contact our office by calling 1-800-447-0360 and ask to speak to the claims department.

The fields of these forms can be completed online but must be printed and signed prior to being returned to our office. For prompt attention, either email the completed claim form and supporting documentation to the claim department at claims@providentbenefits.com or fax to 412-963-0148.

If your Provident Accident & Health policy number begins with PRCO, PRNC or PRST, please use the following first notice of claim form:

If your Provident Accident & Health policy number begins with ESO, please make your selection from the two choices below:

 

24 Hour Accidental Death & Dismemberment First Notice of Claim Forms

If you are filing a 24 Hour Accidental Death & Dismemberment (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 (AD&D) claim and your policy number begins with EXAD, BADD or VOLF please use the following first notice of claim form:

If you are filing a 24 Hour Accidental Death & Dismemberment (AD&D) claim and your policy number begins with 9907, please use the following first notice of claim form:

 Group Term Life First Notice of Claim Forms

If you are filing a Group Life Insurance claim and your policy number begins with G-30175, please use the following first notice of 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:

Beneficiary Designation Form
The form below may be used to designate the beneficiary for your Provident policy. It can be completed online but must be printed and signed afterward.

Completed Beneficiary Forms must be kept on file with your organization.

Federal Public Safety Officers' Benefit Information

Who to better express our commitment to service than our actual claimants:

  • Scott Fleischer, Plumstead Twp FRA, Pennsylvania writes:

    "I would like to thank everyone at Provident for all your help and support over the past year and a half. The shock of having a heart attack at my age was more than I could have imagined. Being a firefighter I have thought I might be injured while fighting a fire, but the last thing I would have thought was having a heart attack.

    I especially want to thank Mark Schmitt for all his support when I wasn't sure what to do; he was there to walk me through it. Mark was always there to answer my questions and always with a kind and understanding attitude. He just said "leave it to me and I'll take care of it. You just concentrate on getting better."

    Provident helped make a difficult situation more bearable. Your help took a lot of stress off my shoulders, which was a large help to my recovery. I would recommend your company to other fire companies. I think they would be in very good hands having you as their insurance carrier. It would be my pleasure to speak on your behalf if you ever need it. I think every fire company in the country should know what a tremendous service you offer. It has been a year and a half since my heart attack and I still haven't received a dime from workers comp but I never missed a days pay thanks to Provident.

    Thanks again,"

The opinions expressed in these testimonials are those of the writer and
reflect that individual's experience with Provident

View additional insurance testimonials and volunteer firefighter stories.

 

Scott Fleischer
View Testimonial >