Disability Insurance

disability insurance companies

Robert J. Peterson, CLU of Guilford, CT has over 40 years as a nationally recognized expert in Long Term Disability Insurance. He spent many years as a award winning manager with one of the industry's leading companies.

Since going out on his own, Bob has become an industry leader in high volume and hard to place cases. Bob represents the leading DI companies in the industry and will make sure you receive the best policy and underwriting consideration based on your occupation and health.

If you would like to discuss your disability needs, please complete the form below and Bob will be in touch within 24 hours.

1. Personal Information
First Name
Last Name
Address
City
State
Zip Code
Daytime Telephone ( ) -
Evening Telephone ( ) -
Best Time to Call
Email Address
Gender
Birthday
Height
Weight lbs.
Tobacco Use
Do you participate in any hazardous activities? Yes No
If yes, please describe:
Marital Status
Number of Dependants
2. Occupational Questions
Occupation
Type of Business
Specialty
Job Duties
Annual Income?  
How long in this occupation?
Self-Employed? Yes No
If yes, Number of employees?
Do you work for the government? Yes No
Do you work at home? Yes No
If yes, what percent of the time?
Do you travel? Yes No
If yes, what percent of the time?
Do you currently have an individual disability policy? Yes No
If yes, please enter name of company
Monthly Benefit
Do you have a short-term or long-term disability benefit through work? Yes No
If yes, please enter number of weeks
Weekly benefit
3. Medical History
1. Have you ever been treated for any of the following? (check all that apply)
AIDS/HIV Hyptertension
Alcohol or Drugs Kidney Disease
Alzheimers Liver Disease
Anxiety Mental Illness
Asthma Pulmonary Disease
Cancer Stroke
Cholesterol Ulcers
Depression Vascular Disease
Diabetes Other
Heart Disease  
2. Do you take any prescription medication? Yes No
If yes, please provide name of medication(s) and dosage.
3. Have any of your parents or siblings had heart disease of cancer prior to age 60? Yes No
4. Have you ever been rated, rejected or postponed for a life or disability policy? Yes No
If yes, please provide details.
4. Coverage Desired
Your maximum monthly benefit is approximately 60% of your monthly income. See Needs Calculator.
Monthly Benefit Desired?
Waiting Period Desired (days) 30 60 90 180
Benefit Period Desired 2 yrs 5 yrs Age 65
5. Submit Application
How did you find us?  
If other: