Life insurance claim form 2026

1. Click ‘Get Form’ to open the life insurance claim form in the editor.
2. Begin by filling out the Employee’s Information section. Enter the patient’s name, relationship to the employee, and employee details including name, date of birth, and social security number.
3. In the Dentist’s Information section, provide details about the dentist including their name, address, and contact information. Indicate if the treatment is a result of an accident or occupational illness.
4. Complete the Examination and Treatment Plan section by listing all services performed. Use the charting system provided to identify teeth and describe each service along with dates and fees.
5. Finally, ensure that all signatures are completed where required. This includes authorizing payment directly to the dentist and confirming that all information is accurate.

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