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Fort dearborn life insurance company death claim form

Fort dearborn life insurance company death claim form 2026

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The document is a Death Claim Form for Group Life and Accidental Death Insurance provided by Dearborn National. It outlines the necessary steps and documentation required for filing a claim upon the death of an insured employee or dependent. Key components include completion sections for both the employer/administrator and beneficiary, instructions for submitting various documents such as a death certificate and payroll records, and details about the Dearborn National Freedom Account for benefit payments. Additionally, it includes fraud notices relevant to different states.

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Click ‘Get Form’ to open the Fort Dearborn Life Insurance Company Death Claim Form in the editor.
Begin with Part 1, which must be completed by the Employer/Administrator. Fill in the Group Name, Group Number, and address details accurately.
Provide information about the deceased employee, including their name, Social Security number, date of birth, and date of death. Ensure all fields are filled out completely.
In Part 2, beneficiaries should enter their personal details such as name, date of birth, and relationship to the deceased. If there are multiple beneficiaries, each must complete a separate form.
Review all sections for accuracy before submitting. Attach required documents like the death certificate and payroll records as specified in the instructions.

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

How long after death can a life insurance policy be claimed?

For additional information regarding the Dearborn Group Life Insurance claim process, please call our Customer Service team at 800-778-2281.

How to file a life insurance death claim?

How do I file a life insurance claim? Get several copies of the death certificate. Call your insurance agent. He or she can help you fill out the necessary forms and act as an intermediary with the insurance company. Submit a certified copy of the death certificate from the funeral director with the policy claim.

How do you claim life insurance when someone dies?

The good news is there is no actual time limit to filing an insurance claim on a life insurance policy. Policies will have a provision in them for when it is possible to file a claim, and most policies have exclusions on when policies can be filed for various types of deaths.