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Get Empire Life Claim Form
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How to fill out the Empire Life Claim Form online
Filling out the Empire Life Claim Form online can seem daunting, but with the right guidance, you can complete it with confidence. This guide provides clear, step-by-step instructions to ensure you fill out the form accurately and efficiently.
Follow the steps to successfully complete your claim form
- Click ‘Get Form’ button to obtain the form and open it in the online editor. Make sure to have all necessary information and documents at hand.
- Complete all required fields in the form. This includes entering your group number, division number, certificate number, and the name of your employer.
- Fill out the insured individual's details, including their name, date of birth, and address. Ensure that you provide a current phone number and email address for correspondence.
- Indicate if employment has been terminated by selecting 'Yes' or 'No' and provide the termination date if applicable.
- If applicable, answer the question regarding worker’s compensation benefits and explain the circumstances if treatment was required due to an accident, including the date and time of the incident.
- Complete the section on other extended health insurance coverage. If applicable, fill in the name of the policyholder and group number for coordination of benefits.
- Enter dependent information for any claims related to eligible dependents, providing their names, dates of birth, and details about the services rendered.
- Sign the certification statement, authorize the necessary information release, and ensure all attached receipts are originals where required.
- Once you have filled out the form, review all information for accuracy. You can then save changes, download, print, or share the completed form as needed.
Start filling out your Empire Life Claim Form online today for a smooth claims process.
To claim your life cover, begin by visiting Empire Life's website for the Empire Life Claim Form. Fill it out carefully, ensuring all details are accurate and complete. After submission, Empire Life will review your claim and communicate any further steps directly to you.
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