Accident insurance

By completing and submitting this form, along with supporting medical documentation, you are submitting a claim on your own behalf, which will be reviewed by Guardian to determine the benefit amount payable under the purchased accident policy.

By completing this form the beneficiary designation will be changed as indicated. Once Guardian receives this form, all other documents pertaining to beneficiaries will be null and void. That means if you want any of the beneficiaries previously named to continue as your beneficiaries, you must include their names on this form.

By completing and submitting this form, along with supporting documentation and certificate of death, you are submitting a claim on behalf of the deceased member, which will be reviewed by Guardian to determine the benefit amount payable under the purchased accident policy.

By completing and submitting this form, along with supporting medical documentation, you are submitting a claim on your own behalf, which will be reviewed by Guardian to determine the benefit amount payable under the purchased accident policy.