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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 Form

      File a claim to receive a death benefit for an insured.

    • 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.

    • Accelerated Benefit for Long-Term Illness Claim Form

      File a claim to receive a portion of a life insurance benefit in advance due to a covered long-term 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.

    • Form W-9

      Complete Form W-9 if you are filing a claim to receive a death benefit for an insured or annuitant.

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 Form W-9 for each payee
  • 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.

American Fidelity Assurance Company
americanfidelity.com