Death Claims
Waiver of Premium Claims
Accelerated Benefit Claims
Accident Claims
Total and Permanent Disability claims (NY Only)
Disability Income Claims
Critical Illness Claims
Administration Forms

DEATH CLAIMS

Remember to complete any applicable Employer's section(s) before distributing forms to beneficiaries.

Form Form Number
Claim form for group policies issued in Florida 48903e (117214)
Claim form for group policies issued in New York 45198j (115813)
Claim form for group policies issued in all other states 40302l (115446)

When you provide the claim form to the beneficiary(ies) to sign, you must also provide settlement options information to EACH beneficiary.

Settlement Options Information Form Number
Settlement Options Brochure for each beneficiary who will receive $5,000 or more unless the group policy was issued in Alaska or if the beneficiary resides in Alaska, Colorado, Kansas, Nevada, North Carolina or North Dakota. 122590 (rev 3/07)
Benefit Settlement Options list for each beneficiary who will receive less than $5,000. Also for all beneficiaries regardless of benefit amount if the group policy was issued in Alaska, or if the beneficiary resides in Alaska, Colorado, Kansas, Nevada, North Carolina or North Dakota. 124886 (rev 12/05)