Filing A Death Claim:
If you have questions about, or need assistance with, filing a Death Claim, please read this information.
Claim Form Instructions:
The claim forms available on this website in PDF format include disability, extended life insurance benefit, accelerated life insurance benefit and dismemberment claims. These claim forms require information to be provided by three parties; the insured employee/retiree, the benefits coordinator and the attending practitioner. The insured employee/retiree must complete the Employee's Statement and have the attending physician fully complete the Attending Practitioner's Statement. The benefits coordinator will forward the fully completed claim form along with any other required documents directly to the Fort Dearborn Life claims office. |
Application PDF's 