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Click ‘Get Form’ to open the DEATH CLAIM REQUEST INSTRUCTIONS in the editor.
Begin by filling out the 'Plan Information' section, including the Plan Name and Plan Number. Ensure accuracy as this information is crucial for processing your claim.
In the 'Deceased Participant Information' section, enter the participant's name, Social Security Number (SSN), date of death, and date of birth. Remember to attach a copy of the death certificate.
Complete the 'Beneficiary Information' section by providing your details, including your relationship to the deceased and your Taxpayer Identification Number (TIN).
Select your preferred withdrawal option in the 'Withdrawal Elections' section. Carefully read each option to ensure you choose one that aligns with your needs.
Review all sections for completeness and accuracy. Any changes must be initialed to avoid delays in processing.
Once completed, submit the form along with any required documentation through our platform for efficient processing.
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Medico-legal / Medical cause of death certificate. First Information Report (FIR) from the police authority. Inquest/ Panchnama Report. Final police investigation report. Postmortem Report (PMR) issued by the hospital. Viscera / Chemical examination report. Newspaper Cutting, if any.
What are the requirements for a death claim?
Generally, you will need: Original Insurance Policy or Policy Number. Duly accomplished Claim Form from the insurance company. Death Certificate (PSA-authenticated). Proof of Identity and/or relationship to the deceased (if claimant is not the policyholder, e.g., a child or spouse).
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You can submit a Proof of Death claim by mail, email or fax. Simply download the form, print, complete and sign. United of Omaha Life Insurance Company | Group
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