Download Life or Accidental Death Claim Form

Our Commitment to You
Eagle American will act as quickly, fairly and compassionately as possible on your claim for Life and/ or Accidental Death insurance benefits. We know that loss of a loved one is stressful. To assist us in doing this, please be sure that the claim form is properly and completely 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 Life Insurance CoversCredit Life insurance is designed to pay the loan off if the insured suffers a loss of life due to sickness or accident occurring while the group certificate or policy is in force. Benefits may or may not include unearned interest on the loan. Please consult the policy or group certificate for exactly what benefits we will pay.
What Credit Accidental Death Insurance CoversCredit Accidental Death insurance is designed to pay the loan off if the insured suffers a loss of life due to an accident occurring while the group certificate or policy is in force. Benefits may or may not include unearned interest on the loan. Please consult the policy or group certificate for exactly what benefits we will pay.
What Credit Life Insurance Does Not CoverGenerally, Eagle American Life will not be liable for the payment of any benefits for loss of life if such loss: (1) is a result of self-destruction while sane or insane and occurs within two years from the Effective Date of coverage listed on the group certificate or policy; (2) is a result of war, whether declared or undeclared.
In the event of any of the above, our liability shall be limited to a full refund of premiums paid.
Certain policies or group certificates may vary slightly from information listed above. Please refer to the policy or group certificate for exact information on what is not covered.
What Credit Accidental Death Insurance Does Not CoverGenerally, Eagle American Life will not be liable for the payment of any benefits for loss of life 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 the insured being intoxicated or under the influence of narcotics unless administered on the advice of a physician; (5) results from the insured’s commission of or attempt to commit a felony or to which a contributing cause was their 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 the front of the policy or group certificate.
 
In the event of any of the above, our liability shall be limited to a full refund of premiums paid.
Certain policies or group certificates may vary slightly from information listed above. Please refer to the policy or group certificate for exact information on what is not covered.
When We Will Consider A ClaimIf the insured passes away, you may immediately complete and fill out our Life/ Accidental Death claim form  and submit it to us.
Who May Complete The Claim FormThe insured’s spouse, immediate family member, estate representative or anyone with power of attorney for the insured’s legal affairs.
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 the 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 Loan ResponsibilitiesIf the insurance certificate or policy is less than two years old, please allow up to eight weeks for processing time. If the insurance certificate or policy is more than two years old, please allow up to three weeks for processing time. We will correspond with you at least once every three weeks and keep you informed. Payment of claims is made directly to the financial institution unless the loan has been fully repaid or the financial institution directs us to do otherwise. Payments on the loan should continue to be made until we have provided you with our final decision regarding the claim.
If any payments were made after the date of death, they 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 case, we will make payment of the excess benefits to either the spouse or the insured’s estate. Late fees may contractually still be charged to the loan by the financial institution.
Contestability of Coverage and Exclusions of CoverageBecause the original application for insurance was most likely our primary source of information in accepting coverage, we may conduct a review of the accuracy of the insured’s answers on the application when we receive the completed claim form (if the claim is filed within two years after taking coverage out). If, upon review, materially incorrect health information is found on the application, the claim may be denied and coverage may be considered void as of the Effective Date. 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.  Also, we may verify whether or not the cause of death is a result of an occurrence that fell within the exclusions contained within the policy or group certificate. If the cause of death is not covered due to an exclusion contained within the policy or group certificate, the claim may be denied and coverage may be considered void as of the Effective Date. 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 Life or Accidental Death Claim Form