Group life insurance claims
Are you a plan administrator?
Use this form to support a life insurance claim for a plan member in your workplace plan. You'll find instructions on how to return the completed form on the form itself.
Download a form
Download the form and print it, or fill it out in Adobe Reader XI or higherOpens a new website in a new window - Opens in a new window (not your browser) and save.
Use this form to support a life insurance claim for a plan member in your workplace plan. Additional documents and medical records may be required.