Claims & Customer Service

Since it was founded in 1936, Surety Life and Casualty Insurance Company has specialized in providing Insurance Protection to individuals and families.

Our desire is to ensure that your claims get processed and paid as quickly as possible. Call us at 1-800-232-3979 if you need help.

Use the following forms for reporting claims, changing beneficiaries, or bank authorizations. Please contact us if you need to submit a change of address or if you have any questions.

There are two types of the same form

  • Docusign digital form
  • Adobe PDF form

CLAIM REPORT FORMS

CHANGE OF BENEFICIARY(S)

BANK AUTHORIZATION

 

How long do I have to report a claim?

If you are injured, we understand that your immediate focus will be on your treatment and recovery. However, it is important to report your claim shortly after your injury or related services within 30 days or as soon as you are medically able to do so.

If you are diagnosed with a critical illness that is covered by your policy, we understand that your immediate focus will be on treatment and recovery. However, it is important to report your claim within 30 days of your diagnosis or as soon as reasonably possible after that.

How do I report a claim for a Policy?

First call Surety at 1-800-232-3979 as soon as possible after you have been diagnosed with a covered critical illness or you have had an accident that required medical treatment. Even if you do not have completed documents, such as physicians’ records or pathology reports. A claim must be started within 30 days of the accident or diagnosis of a covered critical illness or as soon as you are reasonably and medically able to do so.

Surety Life has partnered with DocuSign to offer you a secure way to fill out and sign your claim forms electronically. And attach necessary documentation if required. If you have never used DocuSign please watch the video for instructions.

  • The first thing you will see when you click on the Claim Report Form that applies to the policy you are making a claim for is the PowerForm Signer Information form page. Type in your Full Name and Your Email address. Next, make sure you type in the name and Email address for the Attending Physician or Provider. DocuSign will automatically send the claim to the attending Physician or Provider to fill out their portion. If you are filing a claim for a Cancer Protection or AD&D Form you may need to add a Name and Email Address for your Employer.

*IF YOU ARE FILING A CLAIM IN RELATION TO AN ACCIDENT OR CRITICAL ILLNESS PLAN POLICY

YOU MUST USE THE Accident and Critical Illness Insurance Claim Form TO SUBMIT YOUR CLAIM.

  • Second, once you have the PowerForm Signer Information filled out click on the ‘BEGIN SIGNING’ tab in the upper right corner or below the form. If you have never used DocuSign then you will need to agree to sign electronically and pick or create a signature to use on your documents. An example of this is shown on the video instructions.
  • The application will appear next for you to begin to fill out. Once you have filled out the necessary information then finish clicking all signature tags in the document, confirm signing by clicking  A message appears stating that you have completed your document. You can now download a PDF copy or print a copy of the document. The sender receives an email with the signed document attached, and the signed document appears in their DocuSign account.

Claimant’s Statement:      Insured/Claimant should personally complete the Claimant’s Statement.

Physician Statement:        Have your doctor complete the Physician’s Statement.

Employer’s Statement:     Have your employer complete the Employer’s Statement. (for AD&D claim only)

Pathology/Lab Reports:    Submit a copy of all claim related Pathology/Lab Reports. You may obtain this

information from your doctor’s office. (For Cancer Protection Plan claim only)

Claim related billing:         Submit claim related billing. Contact the Business Office of each hospital

and/or Physician (Clinic), in which services were rendered in relation to your claim. Request and

forward the following billing forms to Surety Life and Casualty at 827 28th St. S Suite C; Fargo, ND 58103

  • Hospital/ER charges should be submitted on a CMS-1450/UB-04 Claim Form
  • Clinical/Physician charges should be submitted on a CMS-1500 Claim Form
  • Please also submit ambulance charges if applicable to your claim.

Please keep in mind that Surety Life is not liable for fees that may incur in relation to the completion of

Physician’s Statements or for records, which are needed to process a claim.

We will promptly proceed with the claims processing upon receipt of all information. Please be

aware that Surety Life is not liable for fees incurred in relation to the completion of physician’s

Statements or for medical records needed to process a claim. We will notify you in the event

additional information is needed in your case.

We are sorry for the unfortunate circumstances making your claim form necessary, but look

forward to being of assistance to you any way we can.

If you have any questions please contact the

Claims Department locally at 701-235-6653, ext. 223 or toll-free at 1-800-232-3979, ext. 223.

*IF YOU ARE FILING A CLAIM IN RELATION TO AN ACCIDENT OR CRITICAL ILLNESS PLAN POLICY

YOU MUST USE THE Accident and Critical Illness Insurance Claim FORM TO SUBMIT YOUR CLAIM.

View frequently asked questions or complete the form below.

Call Surety Life & Casualty at 1-800-232-3979, or complete the form below and you will be contacted as soon as possible.