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Filing a claim for insurance generally means something has gone wrong. At LifeMap we'll do our best to make the process simple and as stress free as possible so you can focus on more important things.
Use this tool to help find the appropriate claim form. Just download and fax or mail the forms to us. And don't hesitate to reach out with any questions you have along the way.
Please note: The state field refers to the location where your employer is headquartered.
Title | Download | Online Form | State |
---|---|---|---|
Accident Claim Form |
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AK, CA, ID, MT, OR, UT, WA, WY | |
Accidental Dismemberment Claim Form |
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AK, CA, ID, MT, OR, UT, WA, WY | |
ADA Dental Claim Form |
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AK, CA, ID, MT, OR, UT, WA, WY | |
Assignment of Life Insurance Proceeds Form for Life Claim Benefits |
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AK, CA, ID, MT, OR, UT, WA, WY | |
Critical Illness Cancer Care Claim Form |
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AK, CA, ID, MT, OR, UT, WA, WY | |
Direct Deposit Form for Claim Benefits |
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AK, CA, ID, MT, OR, UT, WA, WY | |
Extended Life Insurance Claim Form for Employee |
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AK, CA, ID, MT, OR, UT, WA, WY | |
Extended Life Insurance Claim Form for Spouse |
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AK, CA, ID, MT, OR, UT, WA, WY | |
Individual Critical Illness and Emergency Treatment Benefit Claim Form |
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AK, CA, ID, MT, OR, UT, WA, WY | |
Individual Critical Illness Plus Beneficiary Form |
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ID, OR, UT, WA | |
Individual Short Term Medical Pharmacy Reimbursement Form |
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ID, OR, UT, WA | |
Individual Vision Rider Reimbursement Form |
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ID, OR, UT | |
Life Insurance Claim Form |
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AK, CA, ID, MT, OR, UT, WA, WY | |
Long Term Disability Claim Form |
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AK, CA, ID, MT, OR, UT, WA, WY | |
Short Term Disability Claim Form |
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AK, ID, MT, OR, UT, WA, WY | |
Short Term Disability Claim Form - Employee's Statement | Online Form | AK, ID, MT, OR, UT, WA, WY | |
STM Authorization For Use and Disclosure of Protected Health Information |
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ID, OR, UT, WA | |
Vision Out of Network Reimbursement Form |
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AK, ID, MT, OR, UT, WA, WY | |
Wellness Benefit Statement |
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AK, CA, ID, MT, OR, UT, WA, WY |
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