Start a Life Insurance Death Claim

If you are a beneficiary or are legally acting on behalf of one, please complete and submit this form in order to start a death claim on a life insurance policy or annuity contract.

Life Insurance Death Claim
Insured/Deceased Information

Enter as MM/DD/YYYY. Date of birth is not required. But providing the date of birth will help us avoid additional research and assist in identifying the insured and all of their related policies. If exact dates are not known, please provide approximate dates or notate in the comments section information you might find helpful.

Enter as MM/DD/YYYY. Date of death is not required. But providing the date of death will help us avoid additional research and assist in identifying the insured and all of their related policies. If exact dates are not known, please provide approximate dates or notate in the comments section information you might find helpful.

If entering multiple policy numbers, please separate with commas.

Claimant Contact Information

(ex., xxx-xxx-xxxx)

By clicking submit you are requesting Erie Family Life Insurance to review a possible claim on the information provided. This web form is not part of the documentation required to file a claim. Upon review, Erie Family Life Insurance may provide you with the documents required to file a claim. By furnishing forms and investigating the claim, the Company does not admit that there is any insurance in force and does not waive any of its rights or defenses.
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