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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
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Claim Forms
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HIPAA Authorization/Disclosure - Claim Information |
Download |
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Concord Heritage Life Claim Form |
Download |
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Instructions for Group Voluntary Policy Death Claim Form |
Download |
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Instructions for Individual Policy Death Claim Form |
Download |
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Claimant's Statement for Death Claim |
Download |
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Appeals Request Form |
Download |
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Spanish Appeals Request Form |
Download |
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Claimant's Statement for Group Life Insurance |
Download |
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Cancer/Specified Disease/ICU/Heart/Stroke Claims |
Download |
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Critical Illness Claim |
Download |
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Hospital Indemnity Claim |
Download |
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Wellness Claims |
Download |
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Accident/Disability/Waiver of Premium Claims |
Download |
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Group Voluntary STD/LTD/Waiver of Premium Claims |
Download |
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| Mail
claim forms to the address indicated on your claim form
or to the office location listed below: |
Allstate
Workplace Division
P.O. Box 43067
Jacksonville, FL 32203-3067
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| Fax claim
forms to the following phone number: 1-972-510-1773 |
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