Illinois mutual life insurance company forms 2025

1. Click ‘Get Form’ to open the Accident Insurance Claim Form in the editor.
2. Begin by filling in your Policy Number, Claim Number, and Date at the top of the form.
3. In the CLAIMANT’S INFORMATION section, provide your name, date of birth, gender, marital status, and relationship to the policyowner. If you are a dependent student, check the appropriate box.
4. Next, complete the POLICYOWNER’S INFORMATION section with the policyowner's name, address, contact numbers, and email.
5. In the ACCIDENT INFORMATION section, enter the date of the accident and indicate if it was work-related. Describe the accident and provide details about initial medical treatment.
6. Gather and upload required documentation such as medical bills and reports as specified in the REQUIRED DOCUMENTATION section.
7. If applicable, mark any supplemental benefits you wish to claim and complete additional questions related to those benefits.
8. Finally, sign and date the form at the bottom before submitting it through our platform.

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