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Proof of Loss Claimant Statement
Q. What is the "Proof of Loss Claimant Statement?" A. The "Proof of Loss Claimant Statement" is completed by the claimant to make a claim for a policy. You can obtain the form online here or call us.
Customer Service 888 325.5433 Monday – Thursday 8:30 AM – 8 PM ET and Friday 9AM – 8PM ET
Q. Who is the “Claimant”? A. A claimant is the person or entity claiming the death benefit under a policy. Each beneficiary must complete a separate Claimant’s Statement.
Q. After I complete the Claimant’s Statement, can I fax it to you? A. No. We require the original document with original ink signatures.
Q. May I copy this Claimant’s Statement for other claimants’ use? A. Yes. You may copy the form; however, we require original ink signatures on each form submitted to us.
Q. Why is any amount withheld for the payment of taxes . . . I thought life insurance proceeds were income-tax free? A. Generally life insurance death proceeds are income-tax free, but in certain situations, they are taxable, for example when the policy has been transferred for value. Any interest paid on death proceeds is subject to federal and state taxation. We will not withhold income tax from interest unless you are subject to backup withholding, as described below.
Q. Am I subject to backup withholding? A. You are subject to backup withholding at the statutory rate on interest paid if you
Have been notified by the IRS that you have underreported dividends or income
Fail to certify on IRS Form W-9 or a valid substitute form that you are not subject to backup withholding.
Q. What is an IRS Form 712? A. IRS Form 712 is a gift or estate tax form that may need to be filed with the deceased’s final estate tax return. At your request, we will complete this form to provide the value of the policy as of the date of death. For more information, please contact your attorney or tax advisor.
Q. What is a Secure Access Account? A. A Secure Accesssm Account is an interest bearing draft account that is an alternative to receiving proceeds in a lump sum by check. If you select this settlement option, we will send you a draft book to access your account balance, giving you access to all or a portion of the balance whenever you need it. At any time, you may write one draft to withdraw the entire balance, including interest, without fees or penalties. For more information about a Secure Access Account, CLICK HERE or call our Secure Access Customer Service Team at 800 206.4066 from 8:30 a.m. to 4:30 p.m., Eastern Time, Monday through Friday.
Q. Does the signature on the Claimant’s Statement need to be notarized? A. No. The Claimant’s Statement does not have to be notarized, but it must contain original ink signatures.
Q. What is “capacity”? A. Capacity is the legal authority that entitles you to claim proceeds. If you are claiming on your own behalf, you are an “individual claimant” and should indicate your capacity as Individual. Do not use any other “title” unless you are actually claiming in that capacity. See the Special claimant information and signing in capacity instructions section on page 1 on the claim form for details.
Q. If I make a mistake, how do I change information on the Claimant’s Statement? A. Put a line through an incorrect answer and insert the correct information. DO NOT use correction fluid. The claimant must initial all corrections.
Q. Will you accept a copy or fax of the original certified death certificate? A. No. We must have an original certified death certificate.
Q. What makes it a certified death certificate? A. Certified death certificates have either a raised seal or a multicolored signature seal from the county, city or state that issued the certificate. In addition, the original death certificate should contain the signature of an appropriate officer of the county, city or state.
Q. Will you accept a certified death certificate with a pending death cause? A. No. We must have a certified death certificate with a final cause of death. We will return this certificate to you upon request.
Q. Are there any special requirements if the Insured died in a foreign country, i.e., outside the United States or its territories? A. We require an original certified death certificate, and, if appropriate, a Death of an American Citizen Abroad document. A Death of an American Citizen Abroad document is not an acceptable substitute for an original certified death certificate. In addition, we may require a cancelled passport, a copy of airline tickets, funeral/cremation bills, remains transport information/bills, or any other information we deem necessary based on the specific circumstances of your claim. To avoid delays, you should contact us immediately for detailed instructions.
Q. If the primary beneficiary is deceased, is a copy of the certified death certificate acceptable for the deceased primary beneficiary? A. Yes. We only require a copy of the certified death certificate for any deceased beneficiary.
Q. Will you accept a copy of the original policy? A. No. We require the complete original policy, if available. You may make a copy of the original policy for your records.
Q. What if the original policy is lost or otherwise unavailable? A. Simply complete and sign the Claimant’s Statement. By signing the Claimant’s Statement, you are declaring that all original policies and any duplicates and certificates are lost or otherwise unavailable, unless sent in with the Claimant’s Statement.
Q. What claimant information for a trust do I include on the Claimant’s Statement? A. You need to indicate the name of the trust under “Claimant’s Name.” The trust name should include the date of the trust. For “Claimant’s Address,” indicate a trustee’s address where the death proceeds should be delivered.
Q. If there are multiple trustees, how many need to sign the Claimant’s Statement? A. Each current trustee must sign the Claimant’s Statement in his/her capacity as Co-Trustee, unless the Trust document confers on one trustee the authority to act alone.
Q. Why do we require a trust to provide a Tax Identification Number (TIN)? A. A person who is not an individual is required by federal income tax regulations to furnish a TIN to a payor of incA person who is not an individual is required by federal income tax regulations to furnish a TIN to a payor of income. Thus, a trust must submit its TIN. Some trusts are grantor trusts under federal income tax law. The trustee of the grantor trust may provide the social security number of a living grantor (a person treated as the owner of the trust under federal income tax law) instead of the trust’s TIN. In the typical case in which there is a single grantor of the grantor trust and that grantor is the insured who has died, the trustee must furnish the trust’s TIN, not the social security number of the grantor/trustee.
Q. If the beneficiary’s name has changed since the last beneficiary designation, what do I provide to validate the name change? A. If a beneficiary’s name has changed because of marriage or divorce, we require a copy of the marriage certificate or divorce decree. If the beneficiary’s name has changed because of personal preference, we will require a court document indicating the name change from the birth name to the requested name.
Q. Why does a beneficiary have to complete a Claimant’s Statement when there is a collateral assignee? A. To avoid potential disagreements over the amount payable to the beneficiary and the collateral assignee.
Q. Why do you require a statement from the beneficiary and collateral assignee agreeing to the amount claimed by the collateral assignee? A. To avoid potential disagreements over the amounts payable. The agreeing statements, indicating the amount that was due at the time of death of the insured, will expedite processing of your claim.
Q. If the collateral assignment has already been released, what needs to be provided? A. A release of assignment from the collateral assignee. If the assignee is a bank, we will require an officer to sign the collateral assignment release.
Q. Can the death claim proceeds from the policy be assigned to a funeral home? A. Yes. All designated beneficiaries must complete an appropriate assignment form provided by the funeral home, and that form must be submitted to us prior to the payment of the claim along with a Claimant’s Statement for each beneficiary.
Q. If I am signing as the Power of Attorney for the claimant, what do I need to send in as proof? A. Submit a copy of the executed Power of Attorney (POA) papers which give you the power to collect proceeds. You must sign the Claimant’s Statement and indicate your capacity as “Power of Attorney for the Beneficiary.”
Example of a proper signature: Jane Doe by John W. Doe, Attorney-in-fact under POA dated MM/DD/YYYY.
Q. If the beneficiary designation stipulates “surviving” children or siblings or other similar grouping, why do you require a notarized statement from each beneficiary indicating the name of each survivor? A. To validate all applicable beneficiaries and avoid potential disagreements over payment amounts. An agreement among all survivors ensures that we pay the proper amounts to the proper parties and greatly reduces the risk of legal action to restore improper or misdirected payments.