Get the free Living assurance / epcc claim claimant's statement - Great Eastern Life

LIVING ASSURANCE / EPCC CLAIM CLAIMANT S STATEMENT Dear Claimant, We are sorry to learn of your illness/ injury. In order for us to process your claim, we require the following: 1) 2) 3) 4) 5) 6)

Please submit your completed “CHAP-CAM” online on this website and complete the required information: I D — C, and your completed and returned CHAP-CAM will be assigned a priority date and processed. If you wish to be reimbursed later, please submit a letter to the Claimant detailing your reasons. It is of the utmost importance that you complete this form correctly in order to receive payment for the cost of this evaluation. Any change or missing information could delay your payment. Our evaluation of your claim may take longer than expected — for any reason, you agree to pay the entire price of our evaluation without additional fees or delays. I 1. Your full name. 2. Date of Birth (month and day) 2. Address. 3. Telephone number, including area codes & area code. 3. Your telephone number, including area codes & area code. Formal Name 1 of Applicant Date of Birth (month and day) Address Telephone number, including area codes & area code Formal Name of Applicant Date of Birth (month and day) Address Telephone number, including area codes & area code 4. Name of Physician who performed your examination. Formal Name of Physician who performed your examination Date of Birth (month and day) Address Telephone number, including area codes & area code 5. Age at the time of your examination. 6. Physician's signature. 7. Hospital, Clinic, or Treatment facility where you were examined or treated I. Statement of Treatment 1. General description of your current health or symptoms 2. Age at the time you sought treatment 3. Current medical condition or ailment 4. Name and address of facility where you sought treatment 5. Treatment (if any) 6. Hospital or clinic where you were hospitalized or treated 7. Name of medication taken (if any) (The physician will not take your medication or give you a “check list”). 8. How often are you taking medication? 9. The names and addresses of all physicians who have been involved in the care or treatment of you. II. Statement of Background 1. Name and address of your physician's office and office hours 2. Physician's professional references: 3. A complete and accurate medical history 4. List all medications taken that may have been prescribed for you 5.

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What is living assurance epcc claim?

Living assurance epcc claim is a process to claim or request for financial assistance provided to individuals who are insured under a living assurance policy.

Who is required to file living assurance epcc claim?

The policyholder or the beneficiary of the insured individual is required to file the living assurance epcc claim.

How to fill out living assurance epcc claim?

To fill out the living assurance epcc claim, you need to complete the claim form provided by the insurance company. You will need to provide personal information, policy details, and any supporting documents required to substantiate the claim.

What is the purpose of living assurance epcc claim?

The purpose of the living assurance epcc claim is to seek financial support from the insurance company in case of specific events covered by the policy, such as critical illness or disability.

What information must be reported on living assurance epcc claim?

The information that must be reported on the living assurance epcc claim includes the policyholder's or insured individual's personal details, policy number, description of the event or condition triggering the claim, and any supporting documentation like medical reports or diagnosis.

When is the deadline to file living assurance epcc claim in 2023?

The deadline to file living assurance epcc claim in 2023 may vary depending on the terms and conditions of the specific policy. It is recommended to refer to the policy document or contact the insurance company for the exact deadline.

What is the penalty for the late filing of living assurance epcc claim?

The penalty for the late filing of living assurance epcc claim can also vary depending on the policy and insurance company. It is advisable to review the policy terms or consult with the insurance company to understand the specific penalties or consequences of late filing.

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