Life insurance claim forms
How to make a claim
If you have coverage through your employer or plan sponsor, use this form if you are a beneficiary or estate representative making a life insurance claim.
To make a claim:
Step 1: Complete a claim form.
Download the statement and print it or fill it out in Adobe Reader XI or higher - Opens in a new window (not your browser) and save.
Step 2: If applicable, request a certificate of death from the attending physician.
In some cases, you will need to ask the attending physician for a certificate of death. Download this form, and ask them to fill it out.
Step 3: Submit your claim.
Once you’ve filled out and completed the applicable forms, send them to us at firstname.lastname@example.org.