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  • Download Claim Forms

    Please select your state and company below so we can determine the appropriate form you need.

  • If you are encountering issues downloading a form, please contact us at 1-800-424-1592.

    If there is more than one beneficiary, each beneficiary must select the appropriate form by resident state. If the beneficiary is a trust and the trustee lives in a state other than where the trust was created, please use the state of the trust. If the beneficiary is an estate and the administrator/personal representative of the estate lives in another state, please use the state where the estate is being probated. 

    Please Read: If the death occurred outside of the United States, if the death is a result of a homicide or if the death occurred within the contestable period (two years from issue or two years from reinstatement) please contact our office for the appropriate forms. Please note the signature requirements and witness requirements on the claim form. 

    Important Note: Our release of forms in no way constitutes our acceptance of liability. All claims are subject to verification of contract validity and beneficiary status. It may be necessary for us to request additional information from you or someone else (medical provider, coroner, etc.) to properly evaluate your claim. This could result in a delay in the processing of the claim.