The benefit for an accidental bodily injury is payable to an insured as long as the treatment is received as defined by your policy from a qualified institution. Copyright © Globe Life. Please also include copies of the following if applicable: Please include a copy of the 1500 HEALTH INSURANCE CLAIMS FORM or UB-04 form (only associated with hospital visits) and any itemized medical bills you would like to have considered for payment. Therefore, processing times will vary and it may be necessary for us to request additional information in order to process your claim. I’m filing a claim where the manner of death of the insured was homicide, how can I expedite the processing time? Please submit the completed documentation to the following address: Once we receive the documentation, a Claims Analyst will review it and follow up with you regarding the continuance of your Premium Waiver benefits. Please note: If you qualify for Disability benefits, you will be required to provide continued proof of disability at regular intervals, which we will request in writing. diagnosis and procedural codes. Should there not be an estate in place, we will require a document from the courts stating as such. Certain products may not be available in all states. Also, through the life of the policy, the insured may elect to change the beneficiary. Required documentation in addition to Proofs of Death - Claimant Statement: Please mail the completed forms, along with the Death Certificate including cause and manner of death, the obituary (if available) and any other supporting documentation to: Complete the Proofs of Death – Claimant Statement Section A and D only. Please note: If at any time during the review of your claim we find that we need additional information via medical narratives or a police report etc., we will notify you in writing. policy, I have questions not related to a specific policy, Modify As with most insurance companies, claims submitted on policies that have been in effect less than two years require a more detailed examination. The claims process varies for different types of products. Remember to have your employer fill out Part A and your physician fill out Part B on the Disability Claim Form. Select "Globe Life And Accident Insurance Company". Please also include a copy of the complete, itemized hospital bill or UB-04 form (only associated with hospital visits) you would like to have considered for payment. Complete the Claimant Statement. Certified Death Certificates are required for face amounts greater than $15,000; otherwise, a copy is sufficient. We understand that unforeseen circumstances can arise. DFS ORDERS GLOBE LIFE INSURANCE COMPANY OF NEW YORK TO PAY DEATH BENEFITS RESTITUTION TO BENEFICIARIES OF POLICIES TOTALING $7.3 MILLION Globe Life Must Also Pay $439,000 Fine After DFS Examination and Investigation of Company’s Contestable Claims Practices. Printable claim forms are available for your convenience. If you are filing a request for the continuance of Waiver of Premium benefits, you must complete Page 2 of the claim form and have your Physician complete Page 3. Please do not send any Explanation of Benefits (EOB) forms from other insurance companies as we are not able to use these to process claims. Pay premiums, change Policies issued in New York are sold and underwritten by Globe Life Insurance Company of New York. A CMS 1500 is normally associated with clinic or physician visits. The following are not considered cancer for purposes of this policy: For First Occurrence benefits, skin cancer is NOT covered unless it is considered a Melanoma. In addition, the original death certificate should contain the signature of an appropriate officer of the county, city or state. Please answer as accurately as possible. The pathologist establishing the diagnosis shall base his judgment solely on the criteria of malignancy as accepted by the American Board of Pathology or the Osteopathic Board of Pathology. Is there a time frame in which treatment must be received after an Accidental Bodily Injury? Yes! If at any time during the review of your claim we find that we need additional information, we will notify you in writing. Examples of medical records include reports indicating the results of a CT scan, ultrasound or an MRI, and consultation reports verifying the cancer diagnosis and treatment. Please also submit the medical records verifying the date that the heart disease, heart attack, or stroke was diagnosed. Complete the Patient/Claimant section and have the physician complete the Physician Statement. If you are filing a request for the continuance of Disability benefits, you complete section A , have your employer fill out Part C, and your physician fill out Part D of the Claimant Statement. If at any time during the review of your claim we find that we need additional information, we will notify you in writing. Policyholders do have the ability to update beneficiary information at any point during the life of the policy. Monday – Friday. If you haven’t received your check within 30 days of the date your claim was processed, please contact our Customer Service Department. For filing cancer treatment claims after the First Occurrence claim has been processed (e.g., surgery, chemotherapy/radiation treatments, hospital stays, etc. ... Globe Life Insurance Company of New York P.O. You can request a copy from the treatment facility. Please mail the completed Claimant Statement, along with the Certified Death Certificate (including cause and manner of death), and a copy of the obituary (if available) to the following address: Phone: (800) 333-0637 or (205) 325-4979 Please note: For transportation claims, complete the printable travel log. Get a Quote & Apply by Mail Fill out the form below to receive a free information packet by mail which includes rates and an application to apply for coverage. The following examples are for illustration only. Printable claim form can be found here. If a Pathology Report is not available due to a clinical diagnosis of cancer, please include copies of all applicable medical records confirming the positive cancer clinical diagnosis and treatment.

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