Claims Packet or Call-Back Requests

Claims Workflow Request (V. 02.26.24)

Step 1 of 3

Questions regarding billing, refunds, denial of enrollment, and "will this claim be paid" should not be directed to the Claims Department. Doing so will only create a delay or frustration for the caller.

<<Please be sure to address all coverages before you end the call>>
- Agent Submitting Request*
  Enter your name.
- Servicing Location*
  Where you are located.
Claims Specialist Call Back or Claim Forms*
Reminder:

•A call back from a Claims Specialist takes 1-2 business days
•Emailed claims forms can take up to 24-hours
•Mailed claims forms can take 10 to 14 business days

Note: Claim packets cannot be emailed for Transamerica insureds
Call Back Reason*

Please Do Not Submit This Request: Workflows should not be submitted to the Claims Department related to questions about billing, product exclusions, or to ask "Will this claim be paid?" The Claims Team is not able to answer those questions. The agent should refer to scripting in the Knowledge Base.

Caller Information

Caller's Name*
The name of the person who called.
First Middle Last
Phone*
The phone number of the person who called.
Spanish callback required*
Spanish is the preferred language for a callback.
Is the Caller the Primary Insured*
If the caller is the Primary Insured, select "Yes". If the caller is not the Primary Insured, select "No".
Caller's Relationship to Primary*
This is the relationship of the caller to the Primary Insured. (Example: Spouse or Child).

Customer / Member Information

Primary Insured's Name*
The name of the Primary Insured.
First Middle Last
Coverage ID*
The Coverage ID starts with a 6, 7, or 8 and is 9-digits. The Coverage ID will NOT contain any letters.
Deceased or Injured Name*
The name of the person the claim is being filed on.
First Middle Last
Relationship of Injured/Deceased to Primary Insured*
This is the relationship of the person the claim is being filed on to the Primary Insured. (Example: Spouse or Child).

Claim Information

Packet Delivery Method*
Email*
The email address of the person who called.

Who Should the Packet be Addressed To?*
Claim Packet Mailing Address*
The address to where the caller wants the Claim Packet to be sent. Note that this is also the address used in the event an emailed claim packet cannot be delivered.

Street Address Address Line 2 City State ZIP Code

Primary Insured's Mailing Address*
The Primary Insured's mailing address.

Street Address Address Line 2 City State ZIP Code

Product*
The type of Product the Primary Insured has.
Dismemberment Claim or Death Claim*
If AD&D, APP, or AD, please select if the claim is for dismemberment, death, or family leave.
Remember to cancel all policies if the Primary Insured is deceased.
Dismemberment Type*
Claim Date Requirements

Product Date of Accident Date of Loss

AD&D Date of Injury Date of Death or Dismemberment

TERM Date of Injury Date of Death

PKG Date of Injury Date of Death

HAP Date of Injury First Treatment Date

RECUP Date of Illness First Treatment Date

Critical Illness Date of Diagnosis Date of Diagnosis

Injury Care Date of Injury First Treatment Date

Date of Accident / Event*
This date will need to be precise if a claim packet is requested and no call back. Please refer to the Claim Date Requirement chart by Product
MM slash DD slash YYYY

Date of Loss*
This represents the actual date of loss and may be after the accident. Please refer to the Claim Date Requirement chart by Product.
MM slash DD slash YYYY

Cause of Claim*
The reason for filing the claim on the Deceased or Injured person. (Example: Fall, Sick, etc.)
Cause of Recuperative Care Claim
The reason for filing the claim.
Cause of Claim

Claims Workflow Request (V. 02.26.24)

Step 1 of 3

<<Please be sure to address all coverages before you end the call>>

Caller Information

Customer / Member Information

Claim Information

Claim Date Requirements