File a Life Insurance Claim

Life insurance claims cannot be completed online. Download a claim form below to file a life insurance claim by mail or fax.

Life Insurance Claim Forms

- Life Insurance Claim Form
  
  File a claim to receive a death benefit for an insured or annuitant.
- Accidental Dismemberment and Paralysis Claim Form
  
  File a claim to receive a benefit for accidental dismemberment or paralysis if you purchased an additional rider with your policy.
- Accelerated Benefit for Critical Illness Claim Form
  
  File a claim to receive a portion of a life insurance benefit in advance due to a covered critical illness.
- Life Benefit Waiver of Premium Form
  
  If you become totally disabled and you purchased an optional Waiver of Premium Rider for your policy, complete this form to apply for a waiver of premium for your base policy.

Required Documentation

When filing a life insurance claim, you will need to mail or fax the following documentation:

Life Insurance Claim Form: Download, complete, and sign
Certified original death certificate of the deceased showing the Cause and Manner of Death
Completed IRS W-9 form for each payee (a copy of this form is included on the claim form)
A copy of the certified death certificate for the deceased beneficiary
If the insured has an Accidental Dismemberment and Paralysis benefit, please also complete the Accidental Dismemberment and Paralysis Claim Form.

Once completed, please mail or fax the documentation to:
American Fidelity Assurance Company
Life and Annuity - Worksite
P.O. Box 25160
Oklahoma City, OK 73125
Fax Number: 800-818-3453

Need help?

If you have questions about your policy visit the life insurance support page.

Life Insurance FAQs