Quality Insurance

Everyone should be able to access at work quality insurance from a company they trust. That’s our stand. Learn More about our commitment to quality.


Did You Know
We now offer customers the option to file a claim, check claim status, request account changes and see coverage information online at MyBenefits.


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Claim Forms
The documents listed below are PDF documents that require the Adobe
Acrobat Reader® to be installed on your system. Click here to download
a free version.


Claim Forms
Claims Direct Deposit Authorization Form Download
Claimant's Statement for Death Claim Download
Appeals Request Form Download
Spanish Appeals Request Form Download
Claimant's Statement for Group Life Insurance Download
Accidental Death and Dismemberment (AD&D) Claim Download
Cancer/Specified Disease/ICU/Heart/Stroke Claims Download
Critical Illness Claim Download
Wellness Claim Download
Hospital Indemnity Claim Download
GVAP1 Group Accident Claim Download
GVAP2 Group Accident Claim Download
Minimedical/Dental/Group Indemnity Medical (GIM) Claims Download
Group Indemnity Medical 2 Claim Download
Group Voluntary STD/LTD/Waiver of Premium Claims Download
Request for Death Benefit Advance for Life Insurance Policy Download
Request for Death Benefit Advance for Life Insurance Certificate Download
Physician's Certification Download
Outpatient Physician’s Treatment Claim Form Download
Maternity Disability Claim Form Download
GVAP6 Group Accident Claim Download
Individual Accident Claim Download
Disability Claim Download
Attending Physician’s Statement for Disability Claim Download
Employer’s Statement for Disability Claim Download
Authorization to Release Information Download
Enhanced Group Term Life Claim Download
Physician's Certification for GUACI Rider Download
Statement of Claim for Group Term Life GVL-4000 Accelerated Benefits Download
Request for Death Benefit Advance for GUACI Rider (no more than 50%) Download
Request for Death Benefit Advance for GUACI Rider (no more than 100%) Download
 
Mail claim forms to the address indicated on your claim form or to the office location listed below:

Allstate Benefits
P.O. Box 43067
Jacksonville, FL 32203-3067

 
 
Fax claim forms to the following phone number: 1-866-424-8482