7661 Tel 402-2026

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4.8 out of 5

128 votes

The document provides detailed instructions for filing an Accident Benefits Claim with The Standard Life Insurance Company of New York. It includes necessary forms such as the Employee’s Statement, Authorization to Obtain and Release Information, and Attending Physician’s Statement. The document emphasizes the importance of completing all sections accurately to avoid delays in processing claims and outlines the required documentation for various types of claims, including accidental death. Additionally, it contains fraud notices and information regarding confidentiality related to domestic abuse.

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Click ‘Get Form’ to open the 7661 Tel 402 in the editor.
Begin with the Employee’s Statement. Fill in all applicable fields, including your full name, employer, and group policy number. If a question does not apply, write 'NA' to indicate it was not overlooked.
For the section about the Patient, select who the patient is (yourself, spouse, child, etc.) and provide their details as required.
In the Accident section, describe the accident's location and date. Include details about injuries and any relevant reports attached.
Complete additional benefits claimed by attaching necessary receipts or documentation for lodging or transportation benefits.
Sign and date your statement at the bottom of the form before submitting it through our platform.

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Versions	Form popularity	Fillable & printable
2016	4.8 Satisfied (128 Votes)

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