Claims Home
Life Insurance Claims:
Telephone Number
1-800-424-1592
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
Prefix
First Name
*
Middle Initial
Last Name
*
Suffix
Phone Number
*
Email Address
*
Role
*
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
Prefix
First Name
*
Middle Initial
Last Name
*
Suffix
Policy/Contract Number or Social Security Required
*
Policy/Contract Number
Add another policy/contract
Additional Policy/Contract Number
Add another policy/contract
Additional Policy/Contract Number
Social Security Number
Date of Birth
*
Date of Death
*
Cause of Death
*
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.
Manner of Death
*
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'.
Country of Death
*
Do you have any information concerning the beneficiary?
Do you have any information concerning the funeral home/obituary?
Beneficiary Information
Beneficiary Type
Please select whether the beneficiary is a person or an organization.
Organization Type
Please select whether the organization is a company, trust, estate, or other.
Name
Address
Country
Address1
Address2
City
State
Zipcode
Phone Number
Email Address
EIN
This is the employee’s federal identification number.
SSN
Add additional beneficiary
Prefix
First Name
Middle Initial
Last Name
Suffix
Date of Birth
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
Phone Type
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.
Phone Number
Email 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.
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
Role
What is the beneficiary’s relationship to the insured?
Social Security Number
Add additional beneficiary
Funeral Home/Obituary Information
Funeral Home Name
Funeral Home Website
Funeral Home Address
Street
City
State
Zipcode
Funeral Home Email Address
Funeral Home Phone Number
Funeral Home Fax Number
Funeral Home Assignment
This is where all or a portion of the benefit is assigned to be used to cover funeral home costs.
Date of Obituary
When was the obituary published online or in the newspaper?
Newspaper of Obituary
Which newspaper was the obituary published in?
Submit Your Notification
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Service Error
We were unable to process you request at this time. We apologize for any inconvenience this may have caused. For assistance please contact our Life Insurance Claims team at 1-800-424-1592.
