File a universal proof of death claim

We understand losing a loved one can be difficult. That’s why we try to make it as easy as possible when you file a universal proof of death claim. Download the form and follow the steps below to make filing simple.

What you need

  • A certified death certificate
  • The original policy, or an indication on the form that you do not have it
  • Any electronic or paper media coverage of the death or burial to help speed up the claim process

How to complete each section

Section 1 should always be completed by the named beneficiary on the policy.

Section 2 should be completed by the named beneficiary if the policy has been in force for less than two years.

Section 3 should be completed by a physician if the life policy has been in force for less than two years.

Section 4 should be completed by the named beneficiary if the loss was due to an accident.

Section 5 should be completed by a physician if the loss was due to an accident.

Finally, you must fill out and sign the HIPPA authorization found at the end of the form.