Download Dismemberment Claim Form


Our Commitment to You
Eagle American will act as quickly, fairly and compassionately as possible on your claim for dismemberment benefits. To assist us in doing this, please be sure that any claim form you complete is fully and properly filled out before submitting it to us. Wrong information or no information on the claim form will cause us to send it back to you for corrections. 

What Credit Dismemberment Insurance Covers Credit dismemberment insurance is designed to pay your loan off if you suffer dismemberment caused solely by external, violent and accidental means that results in the total and irrevocable loss of sight of one eye, or the loss of one foot by severance or amputation at or above the ankle, or the loss of one entire hand by severance or amputation at or above the wrist occurring while your coverage is in force. Benefits may or may not include unearned interest on your loan. Please consult your policy or group certificate for exactly what benefits we will pay.
What Credit Dismemberment Insurance Does Not CoverGenerally, Eagle American Life will not be liable for the payment of any benefits for dismemberment if such loss: (1) results from any intentionally self-inflicted injury or act of self-destruction; (2) is a result of war, whether declared or undeclared; (3) results from sickness, whether the loss results directly or indirectly from the sickness; (4) results from your being intoxicated or under the influence of narcotics unless administered on the advice of a physician; (5) results from your commission of or attempt to commit a felony or to which a contributing cause was your being engaged in an illegal occupation; (6) occurs more than 180 days after the date of the accident; (7) results from an accident that occurred prior to the Effective Date listed on your policy or group certificate.
Certain policies or group certificates may vary slightly from information listed above. Please refer to your policy or group certificate for exact information on what is not covered.
When We Will Consider Your ClaimIf you have suffered an injury that you believe is covered, you may immediately complete and fill out our Dismemberment claim form  and submit it to us.
Your Claim ResponsibilitiesYou must provide us with a truthful and accurate claim form and any other reasonably necessary information or documents that will assist us in processing your claim accurately. Please be advised that you may be violating state law if you knowingly conceal material facts or submit a claim form that contains materially false information. You have the right to decline to provide Eagle American with the requested information or documents, but Eagle American has the right to discontinue processing of your claim if you choose to deny us access to information that is reasonable and necessary to process your claim.
Processing Time, Payment of Claims and Your Loan ResponsibilitiesPlease allow up to eight weeks for processing time. You should continue to make loan payments until you hear from us. Payment of claims is made directly to your financial institution unless your loan has been fully repaid or your financial institution directs us to do so.
It is your responsibility to keep your loan(s) current and pay any late fees, if they are assessed. The financial institution may contractually charge late fees and report to credit agencies, even if you have insurance on your loan.
Any payments made by you after the date you incur your claim will be accounted for and returned upon payment by us.  Many times, there will be benefits paid that exceed the amount of the loan. In this situation, we will make payment of the excess benefits to you.
Contestability of Coverage and ExclusionsBecause your original application for insurance was most likely our primary source of information in accepting your application, we may conduct a review of the accuracy of your answers on this application when you submit your initial claim form to us (if you file within two years after taking coverage out). If, upon review, materially incorrect information is found on your application, your claim may be denied and your coverage may be considered void as of the Effective Date. In this situation, we will refund 100% of your premium and provide you with a complete description of what information we relied upon in making our decision. 
Also, we may verify whether or not your dismemberment is a result of a medical condition that fell within the Exclusions provisions contained in your insurance policy or group certificate. In this situation, we will refund 100% of the premium and provide you with a complete description of what information we relied upon in making our decision. Please read the “Exclusions” area of the policy or certificate for more information. If you do not have a copy of the policy or certificate, we will provide one for you at no charge upon your request.
Download Dismemberment Claim Form