Insurance Claim Document Upload

Claim upload capabilities are currently only available for long-term care and short-term care insurance claims. For all other claim submissions, please follow the instructions on the claim form.

Step 1 of 3: Contact information

Please provide your name, phone number and email address below to ensure Bankers Life may contact you with any questions.

First name:

The field must be completed

Last name:

The field must be completed

Phone:

The number provided is not in the correct format

Email:

The email provided is not in the correct format

Verify email:

Your email addresses do not match

Optional form fields

If you're submitting this form for an insured, please enter your relationship. You also may include additional comments in the text box.

Relationship to the insured:

Additional comments:

Step 2 of 3:
Insured information

Please enter the first and last name of the insured.

Use contact information

First name:

The field must be completed

Last name:

The field must be completed

Optional form fields

A little more information will help us identify the insured. Please include at least one of the following about the insured: policy number, ZIP code, birth date or phone number.

Policy number:

ZIP code:

Insured date of birth:

The date provided is not in the correct format

Insured phone number:

Step 3 of 3:
Upload document

For a successful upload, use the following file types: PDF or TIF. The document cannot exceed 30 MB.

Choose file to upload:

Choose file No file chosen A file must be selected

Optional form fields

You may include information about your file in the text box.

Additional comments:

Click to read agreement

I have read and understand the agreement.

Document upload

Products Offered

Get a Quote

Step 1 of 3: Contact information

Step 2 of 3: Insured information

Step 3 of 3: Upload document

User Agreement

Step 2 of 3:
Insured information

Step 3 of 3:
Upload document