Αποτελέσματα Αναζήτησης
We are requesting this information in order to process the claim you are presenting to our company. Therefore, please complete in detail, sign, date and return the following form to us.
Monumental Life Insurance Company has assigned the benefits, the claim form must be Claims Department completed by the beneficiary who must submit the original Valley Forge, PA 19493 assignment form.
Monumental Life Insurance Company. If we do not receive the completed claim form within 30 days of your receipt of the claim form, we will assume you no longer wish to file a claim.
INSTRUCTIONS: A CLAIM REPORT MUST BE FULLY COMPLETED BY THE ATTENDING PHYSICIAN, EMPLOYER, AND THE INSURED AT THE END OF EACH 30-DAY PERIOD OF DISABILITY, OR WHEN THE INSURED RESUMES WORK, WHICHEVER OCCURS FIRST. RETURN THIS FULLY COMPLETED REPORT TO THE COMPANY AT THE ADDRESS ABOVE. YOUR CLAIM MAY BE DELAYED IF ALL PARTS ARE NOT FULLY COMPLETED.
MONUMENTAL LIFE INSURANCE COMPANY . Administrative Offices: Summit Administrators, Inc. 110 West Rosamond . Houston, TX 77076-3919 . Toll-Free 1.800.275.3414 FAX 713.694.0298 . DEATH CLAIM FORM . PLEASE HAVE THE DECEASED INSURED’S NEXT-OF-KIN COMPLETE AND SIGN THE AUTHORIZATION FOR RELEASE OF PROTECTED HEALTH INFORMATION . PLEASE PRINT
The document is a claim form for life insurance benefits from Monumental Life Insurance Company, requiring the submission of a completed form along with a death certificate and original policies.
Emailing documents can facilitate in quicker claim processing. Please provide a pathology report confirming a diagnosis of cancer by a certified pathologist. If pathology report not available, provide other supporting medical documentation to confirm cancer diagnosis.
