Proof of Loss Claim Statement - Loyola University Chicago 2025

1. Click ‘Get Form’ to open the Proof of Loss Claim Statement in the editor.
2. Begin with Part I, where the employer must complete and sign all required fields, including the insured's name, date of birth, and policy number. Ensure to attach a job description and proof of earnings.
3. In Part II, the insured should fill out their personal information, including home address and gender. Answer questions regarding the claim's nature, such as whether it is work-related.
4. Complete the AUTHORIZATION FOR USE IN OBTAINING INFORMATION form by providing necessary details about medical care and treatment. This step is crucial for processing your claim efficiently.
5. Finally, ensure that all sections are signed appropriately before submitting via fax or email as indicated in the instructions.

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