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