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.