Salutation*

First Name*

Last Name*

Email Address*

Phone (Cell)*

Phone (Home)

Street Address*

City*

State*

Zip*

Comments

Occupation*

Have you used nicotine products within the last 12 months?*

Health History*

Coverage Information

Annual net income-salaried or self-employed (from Schedule C)*

Do you have any existing disability insurance?*

Government Employee?*

By clicking "Continue", you give consent to Intramark Insurance to contact you at the email address and telephone number provided. This includes if the number is currently on any Do Not Call Lists. This consent is not required, and you may call us directly at 1 (866) 495-4656.

Our Process

Get free disability insurance quotes from multiple companies by by submitting this form. For a quick response, call 866-691-0100 and speak to a disability specialist.

It’s easier than you think to get a disability insurance quote and, ultimately purchase a policy. Just follow the seven easy steps below:

Step 1: Learn About Disability Insurance

This website has a lot of information about disability insurance. Learn (without sales pressure) in the convenience of your home or office. A great place to start is the Disability Insurance Education Center.

Step 2: Request a Disability Insurance Quote

Complete our Disability Insurance Quote Request form. A licensed representative from LifeInsure.com will review your request and email you quotes from several top-rated companies in an easy-to-read quote comparison, usually within 1-2 days. If more information is required to produce quotes, a representative will contact you by phone or email.

Step 3: Request a Quote Review

Your representative will review the quotes with you, help you tailor the policy to your specific needs and, if appropriate, send you an application. The quickest way to receive your application forms is in a .pdf file by email. You may also request traditional mail which takes 3- 5 business days.

Step 4: Complete an Application

Your representative can complete your application over the telephone, or if you would prefer to complete it on your own time, an application will be forwarded to you via mail or email, with all the required application fields highlighted

Step 5: Physical Exam

We will have your insurance carrier’s paramedical examiner contact you and set up a convenient appointment for a physical exam. The physical exam can take place in your home or office, and is performed by a medical professional at no cost to you (the insurance company pays for the exam).

Step 6: Underwriting Process

All insurance companies will have their underwriters review your application before issuing your disability insurance policy. This process typically takes 3-6 weeks depending upon how fast you schedule your paramedical exam and that all additional requests are met in a timely fashion.

Step 7: Approval & Delivery

Once you are approved by the insurance carrier, we will send you your disability insurance policy via express mail. We will then receive confirmation that you received your policy. All insurance carriers are required by law to give policy holders a 30 day free-look period to review their policy and give you the option to cancel within this period.

Disability Insurance Quotes