MidlandNationalBreadcrumb
- Home
- Life Insurance
- Claim Forms
Web Content Display
Claim forms
The Options listed in the brochures below may not be available to all beneficiaries. If you have questions on your available options, please call us toll-free at 800-733-2524. We are available Monday through Thursday from 7:30 am to 5:00 pm, CST and Friday from 7:30 am to 12:30 pm.
Please allow 10 calendar days for the review of any documents submitted for processing. If you have submitted the final requirement for a Claim, our processing goal is 10 calendar days. Processing time may be extended if additional review or documentation is required. Follow up letters are required to be mailed on any outstanding claim requirements preventing us from settling claims. If you have already submitted documents and received a follow up letter requesting these documents, please allow 10 calendar days for processing in addition to mail time.
Asset Publisher
Frequently Used Claim Forms
Beneficiary Information and Instructions (O-2816-2)
Claimant Statement Part II (O-2818-2)
Certification of Trust Agreement (L-3172A)
Certification of Power of Attorney (O-2876)
Affidavit of Surviving Children (O-2794)
Authorization for Release of Information for
Claims Administration (HIPAA) (O-2722)
Contestable Claim Forms
Claimant Statement (Contestable) (O-2818-1C)
Claimant Statement Part II (Contestable) (O-2818-2C)
Authorization for Release of Information for Claims Administration (HIPAA)-Contestable (O-2722C)
Writing Agent Statement for Routine Contestable Claim Investigation
Claim Brochures
