Colonial Life Form 67715 2012 free printable template
Show details
This includes Employer and Attending Physician portions of the claim form. Employer Signature Name of Employer print Title Date Date and Description of the Accident Claimant DIAGNOSIS ICD-9 code s Is condition the result of an accidental injury Yes No If acute injury please provide date and description If re-injury please provide date s and description s Name of Hospital Date s of Confinement Date s of Outpatient Surgery CPT code s Date s of Office Visit s related to this accident Do you have...
pdfFiller is not affiliated with any government organization
Get, Create, Make and Sign Colonial Life Form 67715
Edit your Colonial Life Form 67715 form online
Type text, complete fillable fields, insert images, highlight or blackout data for discretion, add comments, and more.
Add your legally-binding signature
Draw or type your signature, upload a signature image, or capture it with your digital camera.
Share your form instantly
Email, fax, or share your Colonial Life Form 67715 form via URL. You can also download, print, or export forms to your preferred cloud storage service.
How to edit Colonial Life Form 67715 online
Use the instructions below to start using our professional PDF editor:
1
Log in. Click Start Free Trial and create a profile if necessary.
2
Prepare a file. Use the Add New button. Then upload your file to the system from your device, importing it from internal mail, the cloud, or by adding its URL.
3
Edit Colonial Life Form 67715. Rearrange and rotate pages, insert new and alter existing texts, add new objects, and take advantage of other helpful tools. Click Done to apply changes and return to your Dashboard. Go to the Documents tab to access merging, splitting, locking, or unlocking functions.
4
Get your file. When you find your file in the docs list, click on its name and choose how you want to save it. To get the PDF, you can save it, send an email with it, or move it to the cloud.
pdfFiller makes working with documents easier than you could ever imagine. Register for an account and see for yourself!
Uncompromising security for your PDF editing and eSignature needs
Your private information is safe with pdfFiller. We employ end-to-end encryption, secure cloud storage, and advanced access control to protect your documents and maintain regulatory compliance.
Colonial Life Form 67715 Form Versions
Version
Form Popularity
Fillable & printabley
How to fill out Colonial Life Form 67715
How to fill out Colonial Life Form 67715
01
Begin with the personal information section: fill out your name, address, and contact details.
02
Provide your Social Security number and other identification details as required.
03
Complete the section regarding your employment: include your employer's name and details about your job.
04
Fill out the reason for the claim: clearly state the reason you are submitting the form.
05
Attach any necessary documentation: include supporting documents such as medical records or proof of loss.
06
Review all the information for accuracy before submitting the form.
07
Sign and date the form to confirm that all information is truthful and complete.
Who needs Colonial Life Form 67715?
01
Individuals who have experienced a qualifying event such as illness or injury and wish to file a claim.
02
Employees covered under a Colonial Life insurance policy and are seeking benefits related to their coverage.
03
Anyone needing to report an incident that affects their insurance coverage or benefits.
Fill
form
: Try Risk Free
People Also Ask about
How do I claim my life insurance claim?
Filing a Life Insurance Claim You will need to fill a claim form and contact the financial advisor from whom you bought your policy. Submit all relevant documents such as original death certificate and policy bond to your insurer to support your claim.
How long does Colonial Life take to process a claim?
Colonial Life allows customers to file claims through the official website or via fax at any time. However, the carrier does not provide a specific claims response time frame promise. They do state that customers can access their benefit payouts within 48 hours if they've signed up for direct deposit.
How do I submit a claim to Colonial Life?
Simply call (800) 325-4368, and one of our specialists will take care of you. Filing a claim online is a simple 4-step process: Let Colonial know who the claim is for If you need further assistance with filing a claim please contact Colonial Life Customer Service at (800) 325-4368.
How do I collect my life insurance money?
Depending on the insurer, a life insurance payout can typically be distributed in three ways: in the form of a lump sum, via a life insurance annuity, or through a retained asset account.
How much does colonial life pay for a broken bone?
Benefit payable for a chip fracture is 25 percent of the amount shown for closed reduction for the bone involved. Benefit payable for a fracture and a dislocation in the same covered accident is no more than two times the amount for the bone or joint involved which has the highest benefit amount.
How long does colonial life take to process an accident claim?
Colonial Life allows customers to file claims through the official website or via fax at any time. However, the carrier does not provide a specific claims response time frame promise. They do state that customers can access their benefit payouts within 48 hours if they've signed up for direct deposit.
For pdfFiller’s FAQs
Below is a list of the most common customer questions. If you can’t find an answer to your question, please don’t hesitate to reach out to us.
How do I make changes in Colonial Life Form 67715?
pdfFiller not only lets you change the content of your files, but you can also change the number and order of pages. Upload your Colonial Life Form 67715 to the editor and make any changes in a few clicks. The editor lets you black out, type, and erase text in PDFs. You can also add images, sticky notes, and text boxes, as well as many other things.
Can I edit Colonial Life Form 67715 on an Android device?
You can make any changes to PDF files, such as Colonial Life Form 67715, with the help of the pdfFiller mobile app for Android. Edit, sign, and send documents right from your mobile device. Install the app and streamline your document management wherever you are.
How do I complete Colonial Life Form 67715 on an Android device?
Complete Colonial Life Form 67715 and other documents on your Android device with the pdfFiller app. The software allows you to modify information, eSign, annotate, and share files. You may view your papers from anywhere with an internet connection.
What is Colonial Life Form 67715?
Colonial Life Form 67715 is a specific form used by Colonial Life Insurance Company for processing claims related to insurance benefits.
Who is required to file Colonial Life Form 67715?
Individuals who wish to file a claim for benefits under their Colonial Life insurance policy are required to submit Form 67715.
How to fill out Colonial Life Form 67715?
To fill out Colonial Life Form 67715, provide personal and policy information, detail the nature of the claim, and sign the form as required.
What is the purpose of Colonial Life Form 67715?
The purpose of Colonial Life Form 67715 is to formally request the payment of benefits from Colonial Life Insurance based on the terms of the insurance policy.
What information must be reported on Colonial Life Form 67715?
The form requires personal identification details, policy number, claim information, and any necessary documentation to support the claim.
Fill out your Colonial Life Form 67715 online with pdfFiller!
pdfFiller is an end-to-end solution for managing, creating, and editing documents and forms in the cloud. Save time and hassle by preparing your tax forms online.
Colonial Life Form 67715 is not the form you're looking for?Search for another form here.
Relevant keywords
Related Forms
If you believe that this page should be taken down, please follow our DMCA take down process
here
.
This form may include fields for payment information. Data entered in these fields is not covered by PCI DSS compliance.
