Free Forethought Life Insurance Claim Form in PDF

Free Forethought Life Insurance Claim Form in PDF

The Forethought Life Insurance Claim Form is an essential document designed for beneficiaries to claim insurance proceeds following the insured's death. It mandates the completion of all sections and, depending on the circumstances, might require additional documents like a certified death certificate and proof of payment for funeral expenses. Understanding and accurately completing this form is crucial for a smooth claim process. Ready to navigate your claim? Click the button below to get started on your Forethought Life Insurance Claim Form.

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When filing a claim with Forethought Life Insurance Company, understanding the nuances of the Beneficiary Claim Form is crucial. This form serves as the primary document for beneficiaries to formally request the proceeds due from a life insurance policy following the insured's death. The detailed instructions stipulate that all sections must be fully completed to process the claim efficiently. Notably, for claims not involving a funeral home, additional documentation—such as a copy of the itemized at-need bill and the insured's certified death certificate (with specific requirements for Louisiana residents)—is mandatory. Moreover, the form requires personal information from both the claimant and the deceased, alongside a solemn affidavit and taxpayer identification from the claimant, to ensure accuracy and prevent possible fraud. It's imperative that claimants understand the serious implications of providing false information, as outlined in the Fraud Warnings & State Notices section, with legal consequences varying by state. This form, which can be submitted through various channels, including U.S. mail, fax, and email, represents a critical step in the claim process, serving as a guarantee of the claimant's rights and responsibilities towards Forethought Life Insurance Company and its affiliates.

Preview - Forethought Life Insurance Claim Form

Beneficiary Claim Form

Forethought Life Insurance Company

Important Information

All sections of this claim form must be completed.

If a Funeral Home is not claiming proceeds, the following additional items are required:

A copy of the itemized at-need bill, signed and showing the contract is paid in full or a $0.00 balance is due

A copy of the Insured’s certified death certificate (Original death certificate required in Louisiana)

Section A: Claimant Information

Name

 

Social Security Number/Tax ID No. (required)

 

 

 

 

Relationship to Deceased Insured

Daytime Phone Number

Email Address

 

 

 

 

 

Address

City/Town

State

Zip Code

 

 

 

 

Section B: Insured Information

Insured’s Name

 

Policy Number

 

 

 

 

 

Insured’s SSN (Last 4 digits)

Insured’s Date of Birth (mm/dd/yyyy)

Insured’s Date of Death (mm/dd/yyyy)

 

 

 

 

Insured’s Last Address

City/Town

State

Zip Code

 

 

 

 

Section C: Acknowledgement and Claimant Taxpayer Identification (Required)

Affidavit: Under penalty of perjury, I certify that the information provided on this claim form is true and supporting documents are original or unaltered copies of the original documents. I understand that Forethought Life Insurance Company (“Forethought”) is relying upon the accuracy of the information I am providing in this claim, including my statement that I am an heir, policy beneficiary or legal representative with regard to the policy proceeds. I represent and warrant to Forethought that to the extent other parties are legally entitled to the policy proceeds at issue; I will ensure that such other parties receive the share of proceeds they are entitled to. Upon payment of this claim, I further agree to indemnify and hold harmless Forethought and its affiliates from any damages, claims and/or losses of any kind resulting in payment of the above described property. I further agree to indemnify and hold harmless Forethought and its affiliates’ even if Forethought or its affiliates’ negligence contributes in whole or in part to the damages, claims and/or losses of any kind resulting in payment of the above described policy proceeds. I have read and understand the Fraud Warnings and State Notices given to me with this claim form.

Certification: Under penalties of perjury, I certify that:

1.The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me), and

2.I am not subject to backup withholding because:

a)I am exempt from backup withholding; or

b)I have not been notified by the Internal Revenue Service that I am subject to backup withholding as a result of a failure to report all interest or dividends; or

c)the IRS has notified me that I am no longer subject to backup withholding.

Instructions: You must cross out item 2 above if you have been notified by the IRS that you are subject to backup withholding because of underreporting interest or dividends on your tax return. However, if after being notified by the IRS that you were subject to backup withholding you received another notification from the IRS that you are no longer subject to backup withholding, do not cross out item 2.

Signature of Claimant

 

Printed Name

 

Date (mm/dd/yyyy)

This Beneficiary Claim Form can be submitted as follows:

U.S. Mail

Private Express Carrier:

Forethought Life Insurance Company

Forethought Life Insurance Company

P.O. Box 216

One Forethought Center

Batesville, IN 47006

Batesville, IN 47006

Via Fax:

Via Email

Questions? Please Call:

Please fax to (888) 425-2463

Please email to insuranceclaims@gafg.com

(800) 959-6886

A8011-02 (10-16)

Page 1 of 2

Beneficiary Claim Form

Forethought Life Insurance Company

Fraud Warnings & State Notices

California Residents – Reg. 789.8

The sale or liquidation of any asset in order to buy insurance, either life insurance or an annuity contract, may have tax consequences. Terminating any life insurance policy or annuity contract may have early withdrawal penalties or other costs or penalties, as well as tax consequences. You may wish to consult independent legal or financial advice before the sale or liquidation of any asset and before the purchase of any life insurance or annuity contract.

Colorado Residents

It is unlawful to knowingly provide false, incomplete, or misleading facts or information to an insurance company for the purpose of defrauding or attempting to defraud the company. Penalties may include imprisonment, fines, denial of insurance and civil damages. Any insurance company or agent of any insurance company who knowingly provides false, incomplete, or misleading facts or information to a policyholder or claimant for the purpose of defrauding or attempting to defraud the policyholder or claimant with regard to a settlement or award payable from insurance proceeds shall be reported to the Colorado Department of Regulatory Agencies.

District of Columbia Residents

Warning: It is a crime to provide false or misleading information to an insurer for the purpose of defrauding the insurer or any other person. Penalties include imprisonment and/or fines. In addition, an insurer may deny insurance benefits, if false information materially related to a claim was provided by the applicant.

Hawaii, North Dakota, Pennsylvania Residents

Any person who knowingly and with intent to injure, defraud or deceive any insurance company, submits an application for insurance containing any materially false, incomplete, or misleading information, or conceals for the purpose of misleading, any material fact, is guilty of insurance fraud, which is a crime and in certain states, a felony. Penalties may include imprisonment, fine, denial of benefits, or civil damages.

Kansas Residents

Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or knowingly presents false information in an application for insurance may be guilty of insurance fraud as determined by a court of law and may be subject to fines and confinement in prison

Kentucky Residents

Any person who knowingly and with intent to defraud any insurance company or other person files a statement of claim containing any materially false information or conceals, for the purpose of misleading, information concerning any fact material thereto commits a fraudulent insurance act, which is a crime.

Maine and Tennessee Residents

It is a crime to knowingly provide false, incomplete or misleading information to an insurance company for the purpose of defrauding the company. Penalties may include imprisonment, fines or a denial of insurance benefits.

Massachusetts, New Mexico, Louisiana and Rhode Island Residents

Any person who knowingly or willfully presents a false or fraudulent claim for payment of a loss or benefit or who knowingly or willfully presents false information in an application for insurance is guilty of a crime and may be subject to fines and confinement in prison.

New Jersey Residents

Any person who includes any false or misleading information on an application for an insurance policy is subject to criminal and civil penalties.

Virginia Residents

Any person who, with the intent to defraud or knowing that he is facilitating a fraud against an insurer, submits an application or files a claim containing a false or deceptive statement may have violated the state law.

All Other States

Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or who knowingly presents false information in an application for insurance is guilty of a crime and may be subject to fines and confinement in prison.

A8011-02 (10-16)

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Document Specs

Fact Name Description
Complete Form Requirement All sections of the Forethought Life Insurance Claim form must be filled out for the claim to be considered.
Additional Requirements If a Funeral Home is not claiming the proceeds, a signed itemized at-need bill with a $0.00 balance and a copy of the Insured’s certified death certificate are required. An original death certificate is necessary in Louisiana.
Claimant Information Section Claimants must provide their name, social security number or tax ID, relationship to the deceased, contact information, and address.
Insured Information Section Details of the insured such as name, policy number, SSN (last 4 digits), date of birth, date of death, and last address need to be provided.
Acknowledgement and Affidavit Claimants must certify the truthfulness of their provided information and supporting documents, acknowledging their responsibilities towards the distribution of the proceeds and agreements to indemnify Forethought Life Insurance Company.
Submission Methods The filled and signed Beneficiary Claim Form can be submitted via U.S. Mail, private express carrier, fax, or email to the provided addresses and numbers.
Governing Laws for Fraud Warnings State-specific laws and penalties for providing false information are outlined, including criminal and civil penalties in states like California, Colorado, District of Columbia, and others as detailed in the Fraud Warnings & State Notices section.

Instructions on Writing Forethought Life Insurance Claim

Filling out the Forethought Life Insurance Claim form is an important step in initiating a claim process that can bring financial relief during a time of loss. This process requires careful attention to detail to ensure all necessary information is provided correctly. Completion of this form is the first step, followed by the collection and submission of additional required documents. Here is a step-by-step guide to assist you through the form completion.

  1. Section A: Claimant Information
    • Provide the full name of the claimant.
    • Enter the claimant's Social Security Number or Tax ID Number.
    • Indicate the claimant's relationship to the deceased insured.
    • Supply a daytime phone number and an email address for contact purposes.
    • Fill in the claimant's complete address including city, state, and zip code.
  2. Section B: Insured Information
    • Enter the full name of the insured.
    • Provide the policy number associated with the claim.
    • Include the last four digits of the insured’s Social Security Number.
    • Specify the insured's date of birth and date of death in the format mm/dd/yyyy.
    • Fill in the last known address of the insured, along with city, state, and zip code.
  3. Section C: Acknowledgement and Claimant Taxpayer Identification (Required)
    • Read the affidavit carefully, acknowledging the accuracy of the information provided and the claimant’s obligations.
    • Review the certification section, including the taxpayer identification number confirmation and backup withholding status. Cross out item 2 if applicable.
    • Sign and print your name at the bottom of the section, and date it in the format mm/dd/yyyy.
  4. Attach the required documents mentioned in the Important Information section at the beginning of the form. This includes a copy of the itemized at-need bill (if applicable) and a copy of the insured’s certified death certificate. Remember, the original death certificate is required if the claim is being processed in Louisiana.
  5. Review the entire form and attached documentation to ensure all information is accurate and no required details have been omitted.
  6. Submit the completed form and all necessary documentation to Forethought Life Insurance Company. You can do this via U.S. Mail or Private Express Carrier at the addresses provided, via fax, or via email as specified in the form instructions.

After submitting the form and necessary documentation, the claim will be processed by the Forethought Life Insurance Company. The time for processing can vary, so it's important to reach out directly if you have any questions or require a status update on your claim. Their dedicated team is available to provide assistance and support through this process.

Understanding Forethought Life Insurance Claim

What documents are required to file a claim if a Funeral Home is not the claimant?

When a Funeral Home is not filing the claim, the claimant needs to provide a couple of key documents alongside the Forethought Life Insurance Claim Form. These documents include a copy of the itemized at-need bill, which must be signed and show that the contract is paid in full or indicates a $0.00 balance due. Additionally, a copy of the insured’s certified death certificate is required for submission. It is important to note that for claimants in Louisiana, the original death certificate must be submitted.

How can I certify my Taxpayer Identification Number on this form?

On the Forethought Life Insurance Claim Form, certification of your Taxpayer Identification Number (TIN) involves confirming a couple of critical points under penalty of perjury. First, you need to assert that the number you've provided on the form is indeed your correct TIN, or that you are currently in the process of obtaining one. Secondly, you must declare that you are not subject to backup withholding due to either being exempt, never having been notified by the Internal Revenue Service (IRS) of being subject to such withholding for failing to report interest or dividends, or having been notified by the IRS that you are no longer subject to backup withholding. If, however, you have been notified by the IRS that you are subject to backup withholding due to underreporting interest or dividends, you must cross out item 2 before submitting the form.

What are the consequences of providing false information on this claim form?

Providing false information on the Forethought Life Insurance Claim Form has serious ramifications. Laws vary by state, but generally, engaging in such behavior may lead to criminal charges, including imprisonment and/or fines. Specifically, it's noted that for residents in states like Colorado, providing misleading facts or information to an insurance company with the intent to defraud can result in imprisonment, fines, denial of insurance, and civil damages. Other states have similar penalties, emphasizing the significance of providing only truthful and accurate information when filing a claim.

Where can I submit the completed Forethought Life Insurance Claim Form?

Once you have filled out the Forethought Life Insurance Claim Form and gathered all necessary documents, you have multiple options for submitting your claim. You can send it through regular mail to Forethought Life Insurance Company, P.O. Box 216, Batesville, IN 47006. Alternatively, if you prefer a private express carrier, the address is Forethought Life Insurance Company, One Forethought Center, Batesville, IN 47006. For those who find it more convenient, faxing the documents to (888) 425-2463 or emailing them to insuranceclaims@gafg.com are also viable options. Remember to retain copies of all documents for your records and ensure all required sections are accurately completed to avoid any potential delays in the processing of your claim.

Common mistakes

When filling out the Forethought Life Insurance Claim form, individuals often make several mistakes that can lead to delays or denial of the claim. One common error is not completing all sections of the claim form. This form requires thorough attention to detail, and missing any part can result in the inability to process the claim efficiently.

Another frequent oversight is the failure to provide a copy of the itemized at-need bill or a statement showing the contract is paid in full, especially when a funeral home is not claiming the proceeds. This document is crucial for the insurance company to verify that funeral expenses have been settled, which can significantly impact the processing of the claim.

Submitting an incorrect or incomplete certified death certificate is another common mistake. This document is vital for confirming the insured's death and must be presented correctly. For residents of Louisiana, particularly, an original death certificate is required, which is a specific requirement that can be easily overlooked.

Incorrectly filling out the taxpayer identification number or social security number can also hinder the claim's process. This information must be accurate and match the records, as it is essential for tax purposes and the verification of the claimant's identity.

Some claimants neglect to read and understand the fraud warnings and state notices provided with the form. This information is not only legally significant but also outlines the implications of providing false information, which can result in severe legal consequences, including denial of the claim.

Another error involves the acknowledgement and claimant affidavit section. Here, claimants must certify the truthfulness of their information under penalty of perjury. Failing to acknowledge the accuracy and completeness of provided data, or ignoring to indemnify Forethought and its affiliates as required, can be problematic. This legal step is crucial as it protects both the claimant and the company from possible future disputes or claims.

Lastly, not correctly signing and dating the form can invalidate the claim. The signature confirms that the claimant agrees to the terms and certifies the accuracy of the information provided. A missing or incorrect date can also lead to unnecessary delays, as it is part of confirming the timely submission of the claim.

Documents used along the form

When submitting a Forethought Life Insurance Claim form, several other forms and documents are often needed to ensure the process goes smoothly. This is because the insurance company requires comprehensive documentation to verify the claim and expedite the process. Below is a list of these documents, each serving a specific purpose in supporting your claim.

  • Death Certificate: This is a vital document that officially confirms the death of the insured. It provides crucial details such as the date, time, and cause of death, serving as the primary proof for the claim.
  • Proof of Identity for the Claimant: To protect against fraud, the claimant must provide identification documents such as a government-issued ID or passport. This helps verify the claimant's identity as the rightful recipient of the policy proceeds.
  • Policy Document: The original or certified copy of the life insurance policy document is needed. It contains all terms and conditions, including beneficiary information, which the insurance company requires for reference.
  • Claimant Statement: Often a form provided by the insurer, this document requires the claimant to provide details about the deceased and their relationship to them. It may include information about the claimant's financial situation and need for the proceeds.
  • Itemized Funeral Bill: If funeral expenses are to be covered by the insurance, a complete, itemized funeral bill showing payments made is necessary. It must indicate the funeral service provider’s details and the nature of the services rendered.
  • Medical Records/Physician's Statement: Sometimes, insurance companies may request medical records or a physician’s statement regarding the insured's health before their death. This is particularly common if the death was due to natural causes and occurred within a short period after the policy was issued.

It's important to gather all the necessary documents before submitting the insurance claim to minimize delays. Each document plays a critical role in painting a full picture of the circumstances surrounding the insured's death and ensuring that the claimant is the rightful recipient of the proceeds. Accurately completing the Forethought Life Insurance Claim form along with the submission of these necessary documents can significantly streamline the claims process, allowing for a smoother resolution during a challenging time.

Similar forms

The Beneficiary Claim Form for a life insurance policy is closely related to a Health Insurance Claim Form which is used when someone needs to request payment or reimbursement for medical services. Both types of forms require the claimant to provide personal information, details about the policy or coverage, and supporting documents that verify the claim. For the health insurance claim, this might include itemized bills from healthcare providers, whereas for the life insurance claim, it necessitates the submission of a death certificate and, if applicable, proof of funeral expenses.

Similarly, a Disability Insurance Claim Form parallels the life insurance claim form in its structure and purpose. This form is used by individuals who are claiming benefits due to a disability that prevents them from working. Like the life insurance claim, claimants must provide personal information, details about the policy, and medical evidence of the disability. Both forms involve an attestation to the truthfulness of the information provided, under the risk of penalties for fraud.

A Property Insurance Claim Form is another document that bears similarities, designed for policyholders to report damage to their property and seek compensation. It requires the claimant to supply detailed information about the property, the policy number, and a description of the damage or loss incurred, akin to the detailed account and documentation needed for a life insurance claim. Though the context is different, both forms trigger a process where the insurer evaluates the claim based on provided evidence.

An Auto Insurance Claim Form shares the fundamental structure with the life insurance claim form, serving to report an accident or theft to the auto insurer for the purpose of receiving benefits. Claimants must detail the incident, provide policy and personal information, and sometimes submit a police report, similar to the death certificate requirement for a life insurance claim. Verification of claims and providing accurate, honest information is crucial for both forms.

The Employee's Claim for Workers' Compensation Benefits Form, used by employees who sustain work-related injuries or illnesses, also aligns with the life insurance claim form in function and format. It requires detailed personal and policy information, alongside specific information about the injury or illness, often including medical reports, paralleling the need for a death certificate and other documentation in a life insurance claim.

The Pet Insurance Claim Form, while distinct in its focus on animal rather than human life, similarly necessitates detailed information about the policyholder, the policy, and the nature of the claim – in this case, veterinary services received. The principle of providing truthful and detailed information, alongside pertinent records (like veterinary bills versus funeral expenses), applies across both forms.

Finally, a Death Benefit Claim Form for retirement or pension plans mirrors the life insurance claim in many respects. Beneficiaries must provide thorough documentation, including a death certificate, to claim the deceased’s remaining benefits. Both forms are critical for transferring benefits after a policyholder's death, requiring careful attention to detail and honesty in the submission process.

Dos and Don'ts

When dealing with a sensitive task such as filling out a Forethought Life Insurance Claim form, being meticulous and accurate is crucial. The process might seem daunting, but understanding the right and wrong ways to handle it can significantly smooth the experience. Here are ten essential dos and don'ts to guide you through:

  • Do thoroughly read all sections before you start filling out the form to ensure a complete understanding of what is required.
  • Do collect all necessary documents, including the certified death certificate and any additional required items, before beginning the claim process.
  • Do make sure to fill out every section of the claim form completely to avoid delays in processing.
  • Do provide accurate information about the claimant, insured, and the death to ensure the claim is processed smoothly.
  • Do sign and date the form as required, acknowledging the affidavit and certification to validate the claim.
  • Don't leave any sections blank; if a question does not apply, indicating it with “N/A” helps clarify that it was not overlooked.
  • Don't provide false or misleading information on the claim form, as this could lead to criminal penalties or denial of the claim.
  • Don't forget to cross out item 2 under the Certification section if you have been notified by the IRS that you are subject to backup withholding.
  • Don't disregard the state-specific fraud warnings and notices; ensure you understand the legal implications relevant to your location.
  • Don't hesitate to call the provided contact number if you have questions or need further clarification while filling out the form.

Following these guidelines can help ensure that the claim process is as efficient and stress-free as possible for all parties involved. Taking time to double-check the form for accuracy and completeness can make a significant difference in the timeliness of processing your life insurance claim.

Misconceptions

There are several common misconceptions regarding the Forethought Life Insurance Claim form that deserve clarification to ensure beneficiaries understand the claim process thoroughly.

  • Every section must be completed by the claimant personally: While it is crucial that all sections of the claim form are filled out, assistance from a legal representative, financial advisor, or the funeral home (if they are involved in the claim) is acceptable and sometimes advisable to ensure accuracy.

  • An original death certificate is always required: Although the claim form mentions the need for a certified copy of the insured's death certificate, an original is only mandatory in Louisiana. This distinction is important for beneficiaries to understand to avoid unnecessary delays in the claims process.

  • The claimant must always submit an itemized at-need bill: This requirement only applies if a funeral home is not claiming the proceeds. If the funeral home is involved, they will typically handle this aspect of the claim on behalf of the beneficiary.

  • The affidavit is a formality without legal implications: The affidavit section of the claim form is legally binding. Claimants certify under penalty of perjury that the information provided is true and that they are legally entitled to the proceeds, which carries significant legal implications if false information is provided.

  • Claimants are immediately subject to backup withholding: The form specifies conditions under which a claimant is exempt from backup withholding, such as if they are waiting for a taxpayer identification number or have been notified by the IRS that they are not subject to backup withholding. This nuanced detail is critical for understanding potential tax implications.

  • The submission instructions are limited and inflexible: The claim form provides multiple options for submission, including U.S. Mail, private express carriers, fax, and email. This variety of options is designed to accommodate the preferences and needs of different claimants for convenience.

Understanding these nuances ensures that beneficiaries can navigate the claims process with Forethought Life Insurance more effectively, avoiding common pitfalls and misconceptions that could delay the processing of their claim.

Key takeaways

Filling out and using the Forethought Life Insurance Claim form requires attention to detail and accuracy. Here are key takeaways to ensure a smooth process:

  • Every part of the claim form must be thoroughly completed to avoid delays in claim processing.
  • Beneficiaries must provide not just an itemized at-need bill if a funeral home is not claiming the proceeds, but also a certified death certificate of the insured, with originals required in Louisiana.
  • Claimants need to accurately fill in the section on claimant information, including their relationship to the deceased, ensuring all personal details are correctly entered.
  • Providing the insured's information, such as their Social Security Number (SSN), date of birth, and date of death, is crucial for validating the claim.
  • The claim affidavit necessitates the claimant's honesty and the provision of original or unaltered supporting documents, under penalty of perjury.
  • An understanding of the Fraud Warnings and State Notices section is essential, as it outlines the legal implications of providing false information in different states.
  • For claims efficiency, the correct taxpayer identification number of the claimant and their status regarding backup withholding must be certified.
  • The submission of the claim form can be achieved through various means, including U.S. Mail, Private Express Carrier, Fax, or Email, offering flexibility for the claimant.

It's imperative to comprehend and adhere to the instructions and legal declarations made on the Forethought Life Insurance Claim form to facilitate a smooth claim process and ensure compliance with state laws and regulations. This will safeguard both the claimant and the insurance company from potential legal issues and expedite the claim procedure.

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