1. Allstate Group Critical Illness Claim Form: When filing Critical Illness claim, please be sure to include the following:
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1 Dear Policyholder, Per your recent request, enclosed you will find the following forms: 1. Allstate Group Critical Illness Claim Form: When filing Critical Illness claim, please be sure to include the following: Certificate Holder (page 1) This page must be filled out completely with your information. The instructions for filing your claim, including the necessary supporting documentation are also on this page. Attending Physician s Statement (page 2) This page should be completely filled out and signed by your doctor. Please note: This must include specific dates applicable to your type of claim. Authorization (page 3) Please read the statement in the box at the top of the page. You must sign and date where indicated; failure to complete this step may delay the processing of your claim. 2. Allstate Direct Deposit Authorization form (Optional): With direct deposit, you will receive your claim payment faster. This form is to authorize Allstate to deposit your claim payments directly into your checking account in lieu of mailing a paper check. IMPORTANT: There can be no alterations on any of the forms. Once you have all of the necessary documentation required, you can file your claim directly with Allstate. See the appropriate mailing address and fax number on the first page of the claim form for where to send your claim. If you receive a request for additional information or documentation from Allstate, please respond quickly. Failure to respond or provide the requested information may delay the processing of your claim. Please keep in mind that your premiums for all of your policies will need to be paid during the time that you are out of work and not receiving a paycheck. Checks or money orders should be made payable to Allstate and mailed to Allstate at the address below. Allstate Attn: Premium Administration 1776 American Heritage Life Drive Jacksonville, FL If you have any questions about the details of your policies or filing your claim, please contact Allstate s Customer Service Department at Sincerely, BenTec Workplace Solutions
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