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Claims Home Life Insurance Claims: Telephone Number 1-800-424-1592 Start Your Claim We understand the loss of a loved one is very stressful, and we’re here to help in any way we can. During this process, please feel free to reach out at any time. Please fill out and submit the required information through the form below. It is also helpful if you fill out the non-required information as best you can. Using this electronic form enables us to pre-fill much of the claim packet for easier completion. Submitting this form officially notifies us and starts the claim process. We will contact you or the beneficiary listed to follow up and advise you of the next steps in the process. * INDICATES REQUIRED FIELD -- Please correct the errors noted below to complete submission. Tell Us About Yourself Prefix First Name * Middle Initial Last Name * Suffix Phone Number * Email Address * Role * Please let us know if you are a beneficiary, a funeral home representative, or other. Other would be anyone besides the beneficiary or funeral home representative. Address A state is only required if country is United States. If the address is for military personnel please indicate the military installation (i.e. APO, FPO) within the City field, and choose the proper state designator (AA, AE, AP) within the state dropdown along with the military post office box number and any other identifying information in the Address fields. Country Address1 Address2 City State Zipcode Tell Us About the Deceased Prefix First Name * Middle Initial Last Name * Suffix Policy/Contract Number or Social Security Required * Policy/Contract Number Add another policy/contract Additional Policy/Contract Number Add another policy/contract Additional Policy/Contract Number Social Security Number Date of Birth * Date of Death * Cause of Death * The condition or conditions that led to the insured's passing. Often times this is available on the death certificate. This could be a disease, injury, or complication directly causing the death just to provide some examples. Manner of Death * The circumstances that resulted in the death of the insured. Some examples are homicide, suicide or accident. Often times this information is available on the death certificate. If you are uncertain of the manner of death please choose 'Unknown'. Country of Death * Do you have any information concerning the beneficiary? Do you have any information concerning the funeral home/obituary? Beneficiary Information Beneficiary Type Please select whether the beneficiary is a person or an organization. Organization Type Please select whether the organization is a company, trust, estate, or other. Name Address Country Address1 Address2 City State Zipcode Phone Number Email Address EIN This is the employee’s federal identification number. SSN Add additional beneficiary Prefix First Name Middle Initial Last Name Suffix Date of Birth Address A state is only required if country is United States. If the address is for military personnel please indicate the military installation (i.e. APO, FPO) within the City field, and choose the proper state designator (AA, AE, AP) within the state dropdown along with the military post office box number and any other identifying information in the Address fields. Country Address1 Address2 City State Zipcode Phone Type Please select the type of phone associated with the number you’ve provided. If you would like to received text message alerts please provide your cell phone number. Phone Number Email Address A state is only required if country is United States. If the address is for military personnel please indicate the military installation (i.e. APO, FPO) within the City field, and choose the proper state designator (AA, AE, AP) within the state dropdown along with the military post office box number and any other identifying information in the Address fields. Would you like to receive status alerts? This option allows you to enroll in alerts related to your claim. Alerts will be sent to you based off your preferences when documents are received, and when the claim reaches certain statuses. Both email and text alerts are available. Email Text Message and data rates may apply Terms and Conditions Please provide your mobile number Please confirm your mobile number Role What is the beneficiary’s relationship to the insured? Social Security Number Add additional beneficiary Funeral Home/Obituary Information Funeral Home Name Funeral Home Website Funeral Home Address Street City State Zipcode Funeral Home Email Address Funeral Home Phone Number Funeral Home Fax Number Funeral Home Assignment This is where all or a portion of the benefit is assigned to be used to cover funeral home costs. Date of Obituary When was the obituary published online or in the newspaper? Newspaper of Obituary Which newspaper was the obituary published in? The information collected in this form by Protective will be used to offer you services that meet your needs and for other business purposes. Please visit our Privacy Policy for more information about our information practices, including information about your privacy choices. Submit Your Notification × Service Error We were unable to process you request at this time. We apologize for any inconvenience this may have caused. For assistance please contact our Life Insurance Claims team at 1-800-424-1592. Notice: Submitting your claim through our Online Claim Portal does not guarantee your claim will be approved for payment.Life Insurance &Annuity claims are paid after the Company verifies: You are the true and lawful beneficiary.The policy / contract is current and in force.That all conditions of the policy have been met. Please refer to the Company's Privacy Statement and Terms & Conditions for additional information. © Protective Life Corporation, All Rights Reserved. protective.com Opens in a new window | Legal Notice Opens in a new window | Privacy Policy Opens in a new window About Protective Opens in a new window | Claims Home Opens in a new window...