Claim for Extended Life Insurance Benefits - uhd 2025

1. Click ‘Get Form’ to open the Claim for Extended Life Insurance Benefits - uhd in the editor.
2. Begin by filling in your Employee ID and Social Security Number at the top of the form. This information is crucial for identification purposes.
3. In Section 1, enter your full name and date of birth. Ensure that you provide accurate details as they will be used to verify your identity.
4. Indicate your sex and height in Section 2. This information helps in assessing eligibility for benefits.
5. In Section 3, document the date when your health first began to be affected, along with your weight and the last date you worked.
6. Proceed to Section 4 to specify the date you became totally disabled. If not totally disabled, explain any limitations in Section 5.
7. Provide details about the principal cause of disability in Section 6, and if it was due to an accident, elaborate in Section 7.
8. List all physicians consulted during your disability in Section 8, including their names, addresses, and consultation dates.
9. In Section 9, include information about hospitals or institutions where you received treatment during your disability.
10. Finally, review the Agreements and Authorization section carefully before signing and dating at the bottom of the form.

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