American Bankers Claim Forms

Please choose from the following claim forms in order to file a claim.  These forms are available in Adobe Acrobat PDF format. The PDF forms must be printed out and then completed. They cannot be completed online. Once printed and completed, mail it to the address located at the top of the form.  Should you have any questions or need to request an additional form, check out our Frequently Asked Questions page, or contact customer service at 1-800-524-5298. 

HIPAA Medical Authorization Form	This PDF should be sent along with the proper claim form if filing a claim under an ACCIDENT, HOSPITAL INDEMNITY, CANCER, CRITICAL ILLNESS or DISABILITY PLAN.  Failure to sign and submit this form may delay the processing of your claim.
Medical Supplement Claim Form	This PDF should be used to file a claim under an ACCIDENT or HOSPITAL INDEMNITY PLAN , along with the above medical authorization form.  Please read and follow all instructions in paragraph one of the form.
Cancer Claim Form	This PDF should be used to file a claim under a CANCER PLAN , along with the above medical authorization form.  Please read and follow all instructions in paragraph one of the form.  If filing for a wellness benefit, follow the instructions on paragraph two of the form.
Critical Illness Claim Form	This PDF should be used to file a claim under a CRITICAL ILLNESS PLAN , along with the above medical authorization form.  Please read and follow all instructions in paragraph one of the form.  If filing for a wellness benefit, follow the instructions on paragraph two of the form.
Disability Claim Form	This PDF should be used to file a claim under a SHORT-TERM or LONG-TERM DISABILITY PLAN , along with the above medical authorization form.  Please complete Part A numbers 1-8.  Your employer's Benefits Department must properly complete Part B.  Your current treating physician must complete Part C.  Do not complete sections B or C yourself.  Please be sure you have met your elimination period before completing the form.
Life Insurance Claim Form	This PDF should be used to file a claim under a LIFE INSURANCE PLAN .  This form must be completed by the person(s) to whom the benefit is payable.  Please read and follow all instructions at the top of the form.