Colonial Life cancer policyholders use this seven-page claim for diagnosis and treatment benefits. The treating physician completes Section 2 with the diagnosis date, symptoms, treatment dates and work status, and attaches the pathology report. Colonial Life requires that report for the first cancer claim and for any new diagnosis, including skin cancer.
The policy owner completes Section 1, including the cancer type, diagnosis date and all treating physicians. The treating physician completes and signs Section 2, the physician statement.
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Cancer Claim
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Section 2 asks for the primary condition preventing work, when symptoms began, the date cancer was diagnosed with the pathology report attached, treatment dates over the prior 18 months, surgeries with procedure codes, last and next visit dates, expected improvement, work restrictions and unable-to-work dates.
Yes, for the first cancer claim and for any new diagnosis, including skin cancer. The form also requires copies of itemized bills from the surgeon, imaging, radiation or chemotherapy, and the hospital. The physician's Section 2 asks for the diagnosis date with the pathology report attached.
Colonial Life uses a separate form for the transportation benefit under its cancer policy, form 837088, linked on the same cancer claim page. The 74273 cancer claim covers the diagnosis and treatment benefits, with the physician's statement and pathology report.