Preliminary Notice of Disability

To inform Northwestern Mutual of a disability, please complete the following form.

Note: Only one notification is necessary to inform Northwestern Mutual of a disability claim. Upon receipt of the information, a personalized claim kit will be sent to the insured. This kit contains the forms and instructions needed to file a claim.

Insured's Information
All fields marked with * are required
* Insured Name
Phone Number
Contract Number
* Birth Date (mm/dd/yyyy) (Approximate, if unknown)
Date of Disability (mm/dd/yyyy) (Approximate, if unknown)
* Cause of Disability Medical Psychiatric/Substance Abuse
Occupation before disability began
Does the Insured have Northwestern Mutual Group Disability Insurance? No Yes
Notification Completed by
Insured/Insured's Representative
Financial Representative/FRA

Correspondence should be sent to the Insured at the following address
If the claim kit should be sent to anyone other than the insured (or parent of a minor child) call 800-748-9493 to discuss requirements with a service representative.
* Address
* City, State, Zip
If you have any questions, call us at (800) 748-9493, between 7 a.m. and 6 p.m. CST.