Death Claim Processing Guidelines and Instructions
This document provides essential guidelines for processing death claims involving participant accounts. It outlines the requirements and necessary documentation for beneficiaries. Users can find comprehensive details regarding the death claim process and the role of Plan Administrators.
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How do I fill this out?
To fill out the form, begin by collecting all necessary documents, such as the death certificate. Ensure that all sections of the form are completed accurately. Finally, submit the form according to the provided submission guidelines.

How to fill out the Death Claim Processing Guidelines and Instructions?
1
Obtain the official death certificate.
2
Complete all required fields on the form.
3
Verify beneficiary information.
4
Attach necessary documentation.
5
Submit the form as per instructions.
Who needs the Death Claim Processing Guidelines and Instructions?
1
Beneficiaries seeking asset distribution due to a participant's death.
2
Plan Administrators responsible for managing beneficiary claims.
3
Financial institutions needing documentation of death claims.
4
Legal representatives assisting beneficiaries with claims.
5
Family members who want to understand their rights regarding the deceased's assets.
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What are the instructions for submitting this form?
To submit this form, ensure that all required fields are filled out correctly, and attach relevant documentation. You can email the completed form to claims@empower.com or fax it to 1-800-555-0123. You may also submit a physical copy to the nearest Empower office at 123 Main St, Anytown, USA. For best results, double-check that you have included all necessary documents before submission.
What are the important dates for this form in 2024 and 2025?
Important dates for submission may vary by plan. Ensure to check with the Plan Administrator for specific deadlines regarding death claims in 2024 and 2025. Keeping track of these dates is vital to avoid delays in processing benefits.

What is the purpose of this form?
The purpose of this form is to streamline the processing of death claims for participant accounts. It serves as an official request for beneficiaries to access and distribute assets following a participant's death. Proper use of this form ensures compliance with Plan requirements and facilitates the timely settlement of claims.

Tell me about this form and its components and fields line-by-line.

- 1. Beneficiary Information: Includes name, relationship, and contact details of the beneficiary.
- 2. Decedent's Details: Requires the deceased individual's name, date of birth, and date of death.
- 3. Claimant's Signature: A section for the beneficiary to sign, certifying the claim.
- 4. Plan Administrator Section: Space for Plan Administrator's comments and approval.
- 5. Documentation Checklist: Checklist to confirm all necessary documents are attached.
What happens if I fail to submit this form?
Failure to submit this form correctly can delay the claims process. Missing documentation or incomplete information may result in the claim being rejected or returned for corrections.
- Incomplete Information: Claims with missing beneficiary details may be delayed.
- Insufficient Documentation: Required documents like death certificates must be provided.
- Signature Issues: Claims without the appropriate signatures may be rejected.
How do I know when to use this form?

- 1. When a Participant Passes Away: This form is necessary to access the decedent's account assets.
- 2. Claiming Benefits: Beneficiaries use this form to initiate the claims process.
- 3. Updating Beneficiary Status: Utilize this form to verify and update beneficiary information.
Frequently Asked Questions
How do I start the death claim process?
You can initiate the process by submitting the required death certificate and completed claim form.
What documents do I need to provide?
You need an official death certificate and any additional documentation outlined by the Plan.
Can I edit the PDF form directly?
Yes, you can make edits to the PDF using our editing tools on PrintFriendly.
How do I submit the completed form?
Follow the submission guidelines provided in the document, which may include email, fax, or physical mail.
What if the death certificate is not available?
You may need to provide a Report of Death for participants who died abroad.
Can I save the edited PDF?
You can download the edited PDF after making changes, but saving directly on the site is not available.
Who can assist me with this form?
Beneficiaries may contact Empower's Beneficiary Support Services for assistance.
What happens if I submit incorrectly filled forms?
If submitted incorrectly, you will be contacted to provide the missing or corrected information.
Are there deadlines for submission?
It is advisable to submit claims promptly to ensure timely processing of benefits.
Is the form available in other formats?
The form is primarily available as a PDF which you can edit and download.
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