Start a New Claim | Western & Southern Life

Introduction

Before you begin, please note that if you exit at any point during this process, your information will not be saved.

Steps in the Process

About the Insured
About You
Beneficiaries
Review

Items You Will Need

Beneficiary contact information (i.e., email, address, and phone number)
Insured's full name, date of birth, and date of death
Policy number

This video covers what to expect when initiating your claim:
Steps to Submit a Claim Online

Policy Information

To help us locate your policy, please provide your information.

Policy Details

Insured's First Name*

Insured's Last Name*

Policy Number*

About the Insured

Please provide information about the insured individual.

Death Information

Is This a Claim for a Spouse or Child Rider?*

Child's Date of Birth*

Date of Death*

Manner of Death*

Did the insured pass away in the United States?*

Yes

No

After-Death Arrangements

Has an estate been opened for the Insured, or will one be opened?*

Yes

No

Not Sure

About You

Are you a beneficiary of a policy or contract associated with this claim?*

Yes

No

Not Sure

How would you like to receive the benefit?*

Lump Sum Check

Not Sure, Contact Me

Your Social Security Number*

Your Date of Birth*

About You

Please provide your personal details and contact information.

Your Personal Details

First Name*

Last Name*

Address*

City*

State*

Zip*

Your Connection to the Insured

Your Relationship to Insured*

Have you signed a funeral home assignment form?*

Yes

No

Not Sure

Your Contact Info

Email Address*

Confirm Email Address*

Phone*

Beneficiaries

Beneficiary Limit Reached

You can submit up to 4 beneficiaries online. Please remove any additional beneficiaries to continue. The Claims Team will contact you after submission to collect any remaining beneficiary information.

Add any beneficiaries you think are listed on the policy. You may add up to four. The information you provide will be confirmed.

,

DATE OF BIRTH

SOCIAL SECURITY

,

Add Beneficiary

Did the insured pass away in the United States?

After-Death Arrangements

Has an estate been opened for the Insured, or will one be opened?

About You

Your Personal Details

Name

Address

, ,

Your Connection to the Insured

Your Relationship to Insured

Have you signed a funeral home assignment form?

Your Contact Info

Email Address

Phone

About You

Are you a beneficiary of a policy or contract associated with this claim?

How would you like to receive the benefit?

Your Social Security Number

Your Date of Birth

Beneficiaries

There are no beneficiaries to display.

Beneficiary Limit Reached

You can submit up to 4 beneficiaries online. Please remove any additional beneficiaries to continue. The Claims Team will contact you after submission to collect any remaining beneficiary information.

,

DATE OF BIRTH

SOCIAL SECURITY

,

Notices & Signature

There Was a Problem

Please review the information and try again. Some details may be missing or incorrect.

Please acknowledge the Privacy Notice and Fraud Warning Notices, then certify and electronically sign your claim.

Notices

I have reviewed and acknowledged the Privacy Notice.*

I have reviewed and acknowledged the Fraud Warning Notice.*

Claimant Certification

By signing, I certify that:

The information provided, including documents submitted in support of this claim, is true, correct, and complete.
I am named as a beneficiary or claimant under the policy or contract, or I am authorized to sign for the beneficiary, estate, trust, or legal entity.
If applicable, I am the duly appointed and acting personal representative of the estate, or I am fully authorized to sign on behalf of the legal entity named as beneficiary.
The right to receive the proceeds has not been assigned to any third party, except any assignment disclosed in this intake.
If I am an individual, I have not filed for bankruptcy, and my rights as beneficiary are not subject to any pending proceeding, including divorce or bankruptcy, or court order.
The taxpayer identification number I provided is correct, I am not subject to backup withholding unless I have told the company otherwise, I am a U.S. citizen or other U.S. person, and any FATCA code provided is correct.
I acknowledge that I have received and read the Fraud Warning Notices, Privacy Notice, and any other claim attachments.
I understand that the company does not provide tax or legal advice and that I am responsible for the tax consequences of my payment election.

I certify and agree to the statements above.*

Consent to Use of Electronic Records and Signatures

The Western and Southern Life Insurance Company
Western-Southern Life Assurance Company
Columbus Life Insurance Company
The Lafayette Life Insurance Company
Integrity Life Insurance Company
Cincinnati, OH
National Integrity Life Insurance Company
White Plains, NY

Consumer Electronic Signature Consent and Disclosure
IMPORTANT— PLEASE READ CAREFULLY

For purposes of this Consent: “we,” “us,” or “the Company” means the Western & Southern Financial Group and the member company or companies involved in your claim, including The Western and Southern Life Insurance Company, Western-Southern Life Assurance Company, Columbus Life Insurance Company, The Lafayette Life Insurance Company, Integrity Life Insurance Company and/or National Integrity Life Insurance Company. “You” and “your” means each person providing this consent, including but not limited to a beneficiary/claimant, authorized signer, authorized representative, or delegate, as applicable.

What is the purpose and impact of this Electronic Consent and Disclosure?
You have chosen to submit a death claim and/or related claim documents electronically. To do so, you must provide the Company with your consent. Your consent to use electronic records and electronic signatures is voluntary. You are not required to conduct this transaction electronically. If you do not consent, you may request and complete paper claim forms to submit by mail or other available non-electronic methods without losing your right to submit a claim. You may request paper claim forms by contacting the Company by mail at the address below, through your financial representative or by visiting the Contact Us page from the main menu at https://myaccount.westernsouthern.com.

Mail: Western & Southern Financial Group, Inc.
400 Broadway
Cincinnati, OH 45202

By selecting the consent check box and clicking “Submit” or similar button presented with this Consent below, you affirmatively consent to use electronic records, documents, and electronic signatures as described below.

What does this Consent cover once I sign it?
Your consent applies only to this death claim transaction and the documents, notices, disclosures, acknowledgements, agreements, and other records presented or delivered electronically in connection with this claim and signing session. Your electronic signature will be applied only to the documents you review and execute in the applicable signing session. Before signing, you should review each document for completeness and accuracy.

When you consent, you will be providing the Company with your consent to:

a) Sign documents electronically;
b) Be bound with the same force and effect as if you had manually affixed your signature on paper when you click “Submit” or otherwise apply your e-signature to documents received; and
c) All the terms and conditions set forth below in this Consent.

Are there any hardware or software requirements to conduct this transaction electronically?
Yes, you will need access to a computer or device with an internet connection. The preferred browsers are the latest version of Google Chrome, Mozilla Firefox, Microsoft Edge or Safari.

Can I get paper copies of the electronic documents?
Yes, you may obtain paper copies of any electronic documents at any time by contacting the Company. No fees will be imposed to obtain a paper copy.

Should I maintain copies of the electronic documents?
Yes, you should download, print, or otherwise save a copy of this Consent and each electronically signed record for your files. We will maintain electronic records as required by applicable record-retention laws and will make covered records available in a form capable of accurate reproduction for later reference as required by applicable law.

What is the legal effect of my electronic signature?
By consenting, you agree that your use of a keypad, mouse, or other device to (i) select or click “Submit” or similar act, or (ii) communicate your approval of any agreement, acknowledgment, consent terms, disclosures, or conditions constitutes your signature, acceptance, and agreement as if signed by you in writing. You also agree that no certification of authority or other third-party verification is necessary to validate your e-signature and that the lack of such certification or third-party verification will not in any way affect the validity of your e-signature or any resulting agreement between you and the Company. You also agree that your e-signature is the legal equivalent of your manual signature on the claim form as well as any documents attached to this electronic communication, and that you consent to be legally bound thereby.

By selecting the checkbox and clicking the electronic signature button, you acknowledge and agree that you have carefully read and understand this Consumer Electronic Signature Consent and Disclosure, accept it voluntarily and with full knowledge and understanding of its terms and conditions.

Signing Session Consent and Acknowledgement
I have read and reviewed the documents presented to me for this signing session, including any Mutual Agreements contained therein. I confirm that the information I provided is complete and accurate to the best of my knowledge. I hereby consent to the use and application of my electronic signature on all forms I affirmatively execute in this signing session. I understand that my electronic signature is legally binding, carries the same force and effect as a handwritten signature, and will be applied only to the documents executed in this signing session. I further understand that my electronic signature may not be denied legal effect or enforceability solely because it is in electronic form.

I certify and agree to the statements above.*

YOUR FULL LEGAL NAME*

Confirmation

Thank You for Submitting Your Claim

You will receive correspondence from our Claim Department within 2-3 business days outlining beneficiary and death benefit information, as well as additional requirements needed to process the claim, if applicable.

Too Many Attempts

There Was a Problem

We’re unable to process your claim online. Please call us at 1-800-926-1315 to continue filing your claim.

File a Claim

Introduction

Steps in the Process

Items You Will Need

Policy Information

Policy Details

About the Insured

Death Information

After-Death Arrangements

About You

About You

Your Personal Details

Your Connection to the Insured

Your Contact Info

Beneficiaries

Add Beneficiary

Beneficiary Personal Details

Beneficiary Contact Info

Beneficiary Personal Details

Beneficiary Contact Info

Beneficiary Personal Details

Beneficiary Contact Info

Beneficiary Personal Details

Beneficiary Contact Info

Review

Notices & Signature

Notices

Claimant Certification

Consent to Use of Electronic Records and Signatures

Confirmation

Thank You for Submitting Your Claim

Too Many Attempts

Ready to Continue?

File a Claim: Steps to Submit a Claim Online