Filling out the claimant's statement line by line

The claimant's statement is the form that turns a death certificate and a policy number into a payment. Every insurer designs its own, so the order and wording differ, but nearly all of them cover the same ground: who died, which policy, who you are, how you want to be paid, what the tax rules require and a signature under a fraud warning. Filling it out slowly and completely is the single most useful thing a beneficiary controls, because an incomplete form is among the most common reasons a packet comes back.

This walkthrough follows a typical form from top to bottom. Use it as a guide to what each part is for, not as a copy of any company's form. If a question on your form does not match anything here, ask the claims examiner what it means before you write an answer.

Before you start: gather what the form will ask for

You will move faster with these items on the table:

• The insured's full legal name, date of birth, Social Security number and date and place of death
• The policy number, if you have it, and the name of the insurer
• A certified death certificate
• Your own full name, address, phone number, email, date of birth and Social Security number or taxpayer identification number
• Your government-issued identification, if the insurer asks for a copy
• Bank details, if you want a direct deposit
• Any court or trust papers, if you are not an individual adult beneficiary (see documents you need for a life insurance claim)

Download the current form from the insurer's own website or ask the claims department to send it. Old forms floating around in family files are sometimes rejected. The broader process is in how to file a life insurance claim; this post is about the form itself.

Section 1: identifying the insured

The top of the form asks who died. Expect these lines:

• Full legal name. Write it exactly as it appears on the policy and, if you can, as it appears on the death certificate. A nickname, a missing middle name or a maiden name can leave the insurer unable to match the record.
• Other names used. Many forms ask about maiden names and former names. List them. A policy issued twenty years ago may be under a name the person no longer used.
• Date of birth and Social Security number. These let the insurer match the person to the file and check the date of birth against the application. If an age was misstated on the application, the insurer may adjust the benefit under the age provision rather than deny the claim.
• Date and place of death. Copy these from the certified certificate, not from memory. A one-day error causes a mismatch the examiner must chase.
• Cause and manner of death. Some forms ask whether the death was natural, accidental, a suicide or a homicide, and whether there was an investigation. Answer what you know. If you do not know the cause yet, write "pending" or "unknown," as described below, instead of guessing.

What to do when you do not know

Where the form asks for something you cannot find out, write "unknown" or "not applicable," never leave the box blank. A blank can be read as an oversight. A short note such as "cause of death pending medical examiner's report" tells the examiner you read the question.

Section 2: the policy or policies

This part asks which coverage you are claiming.

• Policy number. Take it from the policy, a premium notice or a bank statement showing the payment. If you cannot find it, say so and give the information you do have, such as the agent's name, the approximate year the coverage began or the account the premiums were paid from. Insurers can often search by name and Social Security number.
• Type of coverage. Term, whole life, universal life, group coverage through work, an accidental death benefit or a rider. If you do not know, the insurer can confirm it.
• Other policies with the same company. Some forms ask for all policies on the insured. List every one you know about, so one packet can cover them all.
• Other insurance. A few forms ask whether other life insurance exists on the insured. Answer honestly, including policies at other companies, since examiners compare totals against the application.
• Policy assignments or loans. If the policy was assigned to a lender, or has a loan, the insurer will pay the lender first. The form may ask you to list this. A loan reduces the amount paid, which is explained in your claim letter.

The life insurance claim checklist tracks these details policy by policy if more than one is involved.

Section 3: the claimant's identity and relationship

The insurer needs to confirm that you are entitled to be paid.

• Your full legal name as it appears on your identification and, ideally, on the beneficiary designation. If your name changed since the designation was made, attach the marriage certificate or court order.
• Mailing address and phone. Use an address where you will reliably receive mail for the next few months. Insurers send payment letters and requests for documents there. If you are moving, give the future address and tell the examiner.
• Relationship to the insured. Spouse, child, parent, sibling, friend, business partner, trustee, executor or another description. Be precise. If you are named as a beneficiary but not related, write "named beneficiary."
• Capacity in which you are claiming. Individual beneficiary, trustee, executor or guardian. This is the box described in executor, beneficiary, owner: who does what when a claim is filed. If you check the wrong capacity, the insurer may ask for more documents.
• Date of birth. Required to verify identity and, for a minor, to determine whether a guardian is needed.
• Taxpayer information. Your Social Security number or taxpayer ID. Some insurers ask you to sign an IRS Form W-9 for this purpose. See Section 6.

If more than one person is named, each claimant usually completes a separate statement for his or her own share. A form that says "all beneficiaries" and has one signature line is the exception.

Section 4: the circumstances of the death

Some statements, especially for accident or early claims, include questions about what happened.

• Where the death occurred and whether it was at home, in a hospital or elsewhere
• The name of the attending physician or the medical examiner, if known
• Whether an autopsy was done
• Whether police or an accident investigation took place, and the agency's name
• The names and addresses of doctors and hospitals that treated the insured in recent years

Answer from the documents you hold, such as the death certificate and hospital paperwork. Do not speculate about causes or blame. If you do not know, say so. If a question seems intrusive, call the examiner and ask why it is needed. Often the answer is that the policy has an exclusion or an accident benefit that depends on the facts.

For a death in the first two years of the policy, the form may include a separate authorization asking you to allow the insurer to obtain medical records. That is a normal part of a review in the the two-year contestability period, not an accusation.

Section 5: how you want to be paid

Most forms ask you to choose a payment method. This is one of the few decisions on the form that you cannot easily reverse, so read the options carefully.

The wording and the options vary. The terms lump-sum payment and settlement options are defined in the glossary, and life insurance payout options: lump sum, installments and annuities compares the choices. A retained asset account is covered separately in retained asset accounts: the checkbook you didn't ask for.

Practical points:

• If you want a check or a direct deposit, tick that box clearly. Skipping the question can lead the insurer to a default option.
• If you choose direct deposit, copy the routing and account numbers carefully. Many insurers verify them before sending money.
• If you are unsure, you can often take the lump sum and decide later what to do with it. An installment or retained-asset election may be hard to unwind. A fee-only planner can help with a large benefit.

Section 6: tax forms and interest

The claim form or an attached document asks for your taxpayer identification number. The reason is the interest.

The death benefit is generally not taxable income to the beneficiary, but any interest paid on top of it is taxable and is reported to the IRS. The insurer typically issues a Form 1099-INT in the year after the payment if interest was paid. For the state rules that decide when interest starts, see interest on late life insurance claims.

What to do:

1. Enter your Social Security number or taxpayer ID exactly as the IRS knows it. A typo can lead to withholding or a delayed payment.
2. If a Form W-9 is attached, complete it and sign it; if it is not attached and the insurer asks for one, ask where to find it.
3. If you are a non-U.S. person, ask the insurer which forms apply.
4. Keep the payment letter and any 1099-INT with your tax records.

A tax professional can advise on how the interest and any other income affect your return.

Section 7: the fraud warning and the signature

Nearly every claim form carries a warning, often required by state law, that knowingly providing false information to an insurer to obtain a benefit is a crime. The wording differs by state. It is not a threat aimed at honest beneficiaries; it is there to underline that the form is a statement of facts.

Before signing:

• Read every page, including the small print about authorizations. Some authorizations let the insurer obtain records for a limited time.
• Sign and date every place that asks. Missing signatures on one page are a common reason a packet is returned.
• Use the capacity line if there is one: "Beneficiary," "Executor," "Trustee."
• Notary or witness. A few forms, particularly lost-policy statements, ask for a notary. Banks, shipping stores and some law offices notarize.
• Do not sign a blank or partly blank form for someone else to complete.

A short example of a completed section

The following is hypothetical and does not represent any insurer's form. Say Dana is the named beneficiary of her late father's $200,000 term policy. Her form might read, in part:

• Insured: Robert Alan Smith, also known as Bob Smith; date of birth and date of death copied from the certified certificate
• Cause of death: "Heart attack per the death certificate; no autopsy"
• Policy number: copied from a premium notice
• Other policies with this company: "None known"
• Claimant: Dana Smith Lopez, daughter, claiming as named beneficiary; maiden name Smith, marriage certificate attached
• Payment: lump sum by direct deposit, routing and account numbers checked twice
• Taxpayer ID: entered; W-9 signed
• Signature: signed and dated on each page, with the capacity written beside the name

None of this is complicated. What makes the claim fast is that nothing is blank, names match and the capacity is stated.

Mistakes that send a form back

• Leaving boxes blank instead of writing "unknown" or "not applicable"
• Using an old form or one that does not match the policy type
• Mismatched names between the form, the death certificate and the policy, with no note explaining it
• Signing in the wrong capacity or leaving the capacity line empty
• Forgetting the taxpayer ID or W-9, which stops payment until supplied
• A mistyped bank number, which can delay a direct deposit
• Sending a photocopy where a certified death certificate is required
• Missing pages, usually the authorization or the signature page
• Guessing about the cause of death when it is pending or unknown

After you send it

1. Copy every page before you send the packet.
2. Send it by a trackable method or through the insurer's secure upload.
3. Write down the date, the claim number and the examiner's name.
4. Call within a week to confirm that the packet is complete and ask what else is needed.
5. Keep a log of every contact. If the claim stalls, the log supports the steps in a claim is taking too long: a ladder of steps from phone call to regulator.

Key takeaways

• The claimant's statement identifies the insured, the policy and you, then records how you want to be paid and under what authority you sign.
• Copy names, dates and numbers from the certified certificate and the policy, and write "unknown" rather than leaving a box empty.
• Your payment choice can be hard to reverse, so read the options, ask about interest and take the lump sum if you are unsure.
• The benefit is generally tax-free, but the interest is taxable, which is why the form asks for your taxpayer ID.
• Sign every page that asks, in the right capacity, and keep a full copy of the packet.