Items Needed to File a Death Claim

We will need the following information sent to us by mail in order to evaluate the claim for  benefits. 

1.     DEATH CERTIFICATE

2.    CLAIM FORM COMPLETED BY THE BENEFICIARY

3.    ORIGINAL POLICY 

4.    ASSIGNMENT FORM, IF ANY  (NO SPECIAL FORM REQUIRED)

5.    IF POLICY IS WITHIN 2 YEARS OF ISSUE, A HIPAA MEDICAL AUTHORIZATION RELEASE FORM 

       FUNERAL HOMES MAY USE THEIR STANDARD FORM OR OUR FREEDOM OF CHOICE FORM IF APPLICABLE 

SPECIAL INSTRUCTIONS: 

If death is due to an accident, we will also need the police and accident report.   

For all death claims incurred within the first 2 years of the policy issue date, the completion of the claim form with Part A by the beneficiary and Part B by the physician is required.  

Send the completed information to:  

National Income Life Insurance Company
P.O. Box 5009
Syracuse, New York 13220

CLICK HERE FOR A LIFE CLAIM FORM

CLICK HERE FOR A HIPAA RELEASE FORM