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Accidental Dismemberment Claim Form
Return to Dearborn Life Insurance Company at:
Attention: Claims Department
P.O. Box 7070
Downers Grove, IL 60515Phone Number: (855) 6499648
Fax: (312) 5404706INSTRUCTIONS
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How to fill out accidental death dismemberment
How to fill out accidental death dismemberment
01
Obtain the accidental death dismemberment claim form from your insurance provider.
02
Fill in your personal information such as name, address, policy number, and contact information.
03
Provide details of the accident that led to the accidental death or dismemberment.
04
Include any supporting documents such as police reports, medical records, and witness statements.
05
Review the completed form for accuracy and sign it before submitting it to the insurance provider.
Who needs accidental death dismemberment?
01
Anyone who wants financial protection in the event of accidental death or dismemberment.
02
Individuals who work in high-risk professions or engage in hazardous activities.
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What is accidental death dismemberment?
Accidental death dismemberment is an insurance benefit that provides financial compensation to the insured or their beneficiaries in the event of accidental death or loss of body parts due to an accident.
Who is required to file accidental death dismemberment?
Typically, the insured individual or their beneficiaries are required to file for accidental death dismemberment benefits after an eligible incident occurs.
How to fill out accidental death dismemberment?
To fill out an accidental death dismemberment claim, you need to complete the claim form provided by the insurance company, include necessary documentation such as the death certificate or medical reports, and submit it as instructed.
What is the purpose of accidental death dismemberment?
The purpose of accidental death dismemberment is to offer financial protection and compensation for the insured or their beneficiaries in the case of accidental death or certain injuries resulting in dismemberment.
What information must be reported on accidental death dismemberment?
Reported information typically includes the insured's personal details, the circumstances surrounding the accident, medical records, and any other documentation required by the insurance provider.
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