Start Your Claim

We understand the loss of a loved one is very stressful, and we’re here to help in any way we can. During this process, please feel free to reach out at any time.

Please fill out and submit the required information through the form below. It is also helpful if you fill out the non-required information as best you can. Using this electronic form enables us to pre-fill much of the claim packet for easier completion. Submitting this form officially notifies us and starts the claim process. We will contact you or the beneficiary listed to follow up and advise you of the next steps in the process.

* INDICATES REQUIRED FIELD -- Please correct the errors noted below to complete submission.

Tell Us About Yourself

Please let us know if you are a beneficiary, a funeral home representative, or other. Other would be anyone besides the beneficiary or funeral home representative.

Address

A state is only required if country is United States. If the address is for military personnel please indicate the military installation (i.e. APO, FPO) within the City field, and choose the proper state designator (AA, AE, AP) within the state dropdown along with the military post office box number and any other identifying information in the Address fields.

Country Address1 Address2 City State Zipcode

Tell Us About the Deceased

The condition or conditions that led to the insured's passing. Often times this is available on the death certificate. This could be a disease, injury, or complication directly causing the death just to provide some examples.

The circumstances that resulted in the death of the insured. Some examples are homicide, suicide or accident. Often times this information is available on the death certificate. If you are uncertain of the manner of death please choose 'Unknown'.

Policy/Contract Number or Social Security Required

Beneficiary Information

Please select whether the beneficiary is a person or an organization.

Please select whether the organization is a company, trust, estate, or other.

This is the employee’s federal identification number.

Address

Country Address1 Address2 City State Zipcode

Please select the type of phone associated with the number you’ve provided. If you would like to received text message alerts please provide your cell phone number.

What is the beneficiary’s relationship to the insured?

Would you like to receive status alerts? This option allows you to enroll in alerts related to your claim. Alerts will be sent to you based off your preferences when documents are received, and when the claim reaches certain statuses. Both email and text alerts are available.

Email Text Message and data rates may apply Terms and Conditions

Please provide your mobile number

Please confirm your mobile number

Address A state is only required if country is United States. If the address is for military personnel please indicate the military installation (i.e. APO, FPO) within the City field, and choose the proper state designator (AA, AE, AP) within the state dropdown along with the military post office box number and any other identifying information in the Address fields.

Country Address1 Address2 City State Zipcode

Funeral Home/Obituary Information

This is where all or a portion of the benefit is assigned to be used to cover funeral home costs.

When was the obituary published online or in the newspaper?

Which newspaper was the obituary published in?

Funeral Home Address

Street City State Zipcode

The information collected in this form by Protective will be used to offer you services that meet your needs and for other business purposes. Please visit our Privacy Policy for more information about our information practices, including information about your privacy choices.

Don't want to provide this information online? Call us at Telephone Number1-800-424-1592