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Group Life and AD&D Claim Form

 

 

Which claim form should I use - with Safe Haven or without?

Safe Haven is an option for receipt of insurance proceeds and is available for claim amounts that are greater than $10,000. Proceeds are deposited by Hartford Life Insurance (HLI) into a draftbook (functions the same as a checkbook) that is sent to the beneficiary. Select this form if you prefer this option.

If the beneficiary prefers a lump-sum check or if the claim amount is for $10,000 or less, then choose the "Group Life and AD&D Claim Form-No Safe Haven" option.

 

The Employer Certification section of the form shows "CBIA Service Corporation" as the employer. Whose signature is needed for this section?

All CBIA groups are included under the CBIA Service Corporation policy with HLI. For the claim to be accepted by HLI this information must appear on the form along with the CBIA Group Policy Numbers (703586 / 677347). If this information does not appear on the form, HLI is unable to recognize your group as a covered entity and the claim will be denied.

However, the Employer Certification section requires that the actual employer of the deceased complete this section. We recommend that the employer’s company name be added AFTER "CBIA Service Corporation." For example, "CBIA Service Corporation - Joe's Garage." The address and signature would apply to "Joe’s Garage."