Accelerated Benefit Claims
Not all group life policies have this option - check your certificate. Remember to complete any applicable Employer's section(s) before distributing forms to employees/insureds.
To submit a claim, you need to distribute the following forms to the employee/insured:
- Claim form
- Attending Physician's Statement of Terminal Condition
- Authorization for Release of Health-Related Information
- Consumer Privacy Notice
- Disclosure Statement
| Form Name | Form Number |
|---|---|
121585 (rev 11/10) | |
121488 (rev 11/10) | |
121583 (rev 12/12) | |
Attending Physician's Statement of Terminal Condition (all states) | 121489 (rev 12/12) |
127182 (rev 10/04) | |
47316c (116249) |
| Disclosure Statements | Form Number |
|---|---|
Disclosure Statement for group policies issued in Connecticut | 44539CT |
44539IL (rev 2/02) | |
44539KY (3/09) +159144 | |
Disclosure Statement for group policies issued in Massachusetts | 43734c |
44539MT (rev 2/02) | |
44539OR (8/05) + 154673 | |
Disclosure Statement for group policies issued in Washington | 44539WA (rev 4/09) + page 2 |
Disclosure Statement for group policies issued in ALL OTHER STATES except New York | 44539 (rev 2/02) |
Disclosure Statement for individual portable policies issued to individuals in Montana | 44539MT (rev 2/02) |
Disclosure Statement for individual portable policies issued to individuals in Washington | 44539WA (rev 4/09) + page 2 |
44539 (rev 2/02) |
Employee Benefits insurance products and services in the U.S. are provided by ReliaStar Life Insurance Company (Minneapolis, MN) and ReliaStar Life Insurance Company of New York (Woodbury, NY). Within the State of New York, only ReliaStar Life Insurance Company of New York is admitted, and its products issued. Both are members of the ING U.S. family of companies. Product availability and specific provisions may vary by state. Each insurer is solely responsible for the financial obligations under the policies or contracts it issues.
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