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Prudential life insurance claim form

Prudential: Group Life Insurance Claim Form - Leidos Benefits 2026

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The document provides detailed instructions for completing and submitting a Group Life Insurance Claim Form to The Prudential Insurance Company of America. It outlines the necessary sections to fill out, required documents to attach (such as death certificates and beneficiary statements), and guidelines for beneficiaries. Additionally, it explains the options available for receiving life insurance payments, including the establishment of an interest-bearing Alliance Account, alternative settlement options, and important legal warnings regarding fraudulent claims.

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Click ‘Get Form’ to open the Prudential: Group Life Insurance Claim Form in our platform.
Begin by completing Sections 1 through 5 of the Group Contract Holder Statement. Ensure that Section 1 is filled out if the claim is for an employee/member or their dependent, and specify the 'Relationship to Employee'.
Attach the Beneficiary Statement and distribute copies to each beneficiary. Each beneficiary must complete their statement, but you only need to submit one Group Contract Holder Statement regardless of the number of beneficiaries.
Return both the completed Group Contract Holder Statement and all Beneficiary Statements along with required documents such as a certified death certificate and any other necessary attachments to Prudential's address provided on the form.

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