Feb 06, 2018
Allianz - claims-lighthouse-header_1600x300

Your Claim {{claim.Number}}

The status of your claim is provided below.

 

Claim Detail

Claim Type: {{bill.Description}}
 
  • Claim Reported - Awaiting Documentation
  • Claim & Documentation Received - Under Review
  • Processing
  • Complete
Current Status

Claim Reported - Awaiting Documentation

Thank you for notifying us of your loss. We're sorry things didn't go as planned, but want to make sure your claim process goes smoothly. In order to begin processing your claim, we need supporting documentation. The list of items needed for your claim is listed below. Please upload your documents and/or images as soon as possible so we can start our review process. Once submitted, please allow 7-10 business days for review. If additional information is needed, we will let you know. As always, you can check the status of your claim online at any time.

 

Check #
Check Date
Amount
Payable To
Address
{{payment.CheckNumber}} Check # {{payment.CheckNumber}}
{{payment.CheckDate|date:'MM/dd/yyyy'}} Check Date {{payment.CheckDate|date:'MM/dd/yyyy'}}
{{payment.AmountPaid.Amount|currency}} Amount {{payment.AmountPaid.Amount|currency}}
{{payment.PayeeName}} Payable To {{payment.PayeeName}}
{{payment.Address}} Address {{payment.Address}}
 
Bank Name
Account
Payable To
Date
Amount
{{payment.BankName | lowercase}} Bank Name {{payment.BankName | lowercase}}
Ending in -{{payment.AccountNumber}} Account Ending in -{{payment.AccountNumber}}
{{payment.PayeeName}} Payable To {{payment.PayeeName}}
{{payment.PaymentDate|date:'MM/dd/yyyy'}} Date {{payment.PaymentDate|date:'MM/dd/yyyy'}}
{{payment.AmountPaid.Amount|currency}} Amount {{payment.AmountPaid.Amount|currency}}
 
Debit Card#
Name on Card
Payment Date
Amount
Funds Availability
Ending in - {{payment.CardNumber}} Debit Card# Ending in - {{payment.CardNumber}}
{{payment.PayeeName}} Name on Card {{payment.PayeeName}}
{{payment.PaymentDate|date:'MM/dd/yyyy'}} Payment Date {{payment.PaymentDate|date:'MM/dd/yyyy'}}
{{payment.AmountPaid.Amount|currency}} Amount {{payment.AmountPaid.Amount|currency}}
{{payment.FundsAvailable | lowercase}} Funds Availability {{payment.FundsAvailable | lowercase}}
 

Claim Reported - Awaiting Documentation

Thank you for notifying us of your loss.  We're sorry things didn't go as planned, but want to make sure your claim process goes smoothly. In order to begin processing your claim, we need supporting documentation. The list of items needed for your claim is listed below.  Please upload your documents and/or images as soon as possible so we can start our review process. Once submitted, please allow 7-10 business days for review. If additional information is needed, we will let you know.  As always, you can check the status of your claim online at any time.  

 

Check #
Check Date
Amount
Payable To
Address
{{payment.CheckNumber}} Check # {{payment.CheckNumber}}
{{payment.CheckDate|date:'MM/dd/yyyy'}} Check Date {{payment.CheckDate|date:'MM/dd/yyyy'}}
{{payment.AmountPaid.Amount|currency}} Amount {{payment.AmountPaid.Amount|currency}}
{{payment.PayeeName}} Payable To {{payment.PayeeName}}
{{payment.Address}} Address {{payment.Address}}
 
Bank Name
Account
Payable To
Date
Amount
{{payment.BankName | lowercase}} Bank Name {{payment.BankName | lowercase}}
Ending in -{{payment.AccountNumber}} Account Ending in -{{payment.AccountNumber}}
{{payment.PayeeName}} Payable To {{payment.PayeeName}}
{{payment.PaymentDate|date:'MM/dd/yyyy'}} Date {{payment.PaymentDate|date:'MM/dd/yyyy'}}
{{payment.AmountPaid.Amount|currency}} Amount {{payment.AmountPaid.Amount|currency}}
 
Debit Card#
Name on Card
Payment Date
Amount
Funds Availability
Ending in - {{payment.CardNumber}} Debit Card# Ending in - {{payment.CardNumber}}
{{payment.PayeeName}} Name on Card {{payment.PayeeName}}
{{payment.PaymentDate|date:'MM/dd/yyyy'}} Payment Date {{payment.PaymentDate|date:'MM/dd/yyyy'}}
{{payment.AmountPaid.Amount|currency}} Amount {{payment.AmountPaid.Amount|currency}}
{{payment.FundsAvailable | lowercase}} Funds Availability {{payment.FundsAvailable | lowercase}}
 

Claim Reported - Awaiting Documentation

Thank you for notifying us of your loss and we're sorry things didn't go as planned. Our records indicate that we have not yet received any supporting documentation. Unfortunately, we cannot proceed with reviewing your claim until we receive the documents we need. If you have questions about what documents may be required for your claim type, please check below or give us a call at 1-800-334-7525. Please note: if we have not received documentation within 60 days of the first notice of loss, we will place your claim on hold. We are happy to re-open it at any time if you decide to proceed.

 

Check #
Check Date
Amount
Payable To
Address
{{payment.CheckNumber}} Check # {{payment.CheckNumber}}
{{payment.CheckDate|date:'MM/dd/yyyy'}} Check Date {{payment.CheckDate|date:'MM/dd/yyyy'}}
{{payment.AmountPaid.Amount|currency}} Amount {{payment.AmountPaid.Amount|currency}}
{{payment.PayeeName}} Payable To {{payment.PayeeName}}
{{payment.Address}} Address {{payment.Address}}
 
Bank Name
Account
Payable To
Date
Amount
{{payment.BankName | lowercase}} Bank Name {{payment.BankName | lowercase}}
Ending in -{{payment.AccountNumber}} Account Ending in -{{payment.AccountNumber}}
{{payment.PayeeName}} Payable To {{payment.PayeeName}}
{{payment.PaymentDate|date:'MM/dd/yyyy'}} Date {{payment.PaymentDate|date:'MM/dd/yyyy'}}
{{payment.AmountPaid.Amount|currency}} Amount {{payment.AmountPaid.Amount|currency}}
 
Debit Card#
Name on Card
Payment Date
Amount
Funds Availability
Ending in - {{payment.CardNumber}} Debit Card# Ending in - {{payment.CardNumber}}
{{payment.PayeeName}} Name on Card {{payment.PayeeName}}
{{payment.PaymentDate|date:'MM/dd/yyyy'}} Payment Date {{payment.PaymentDate|date:'MM/dd/yyyy'}}
{{payment.AmountPaid.Amount|currency}} Amount {{payment.AmountPaid.Amount|currency}}
{{payment.FundsAvailable | lowercase}} Funds Availability {{payment.FundsAvailable | lowercase}}
 

Claim & Documentation Received - Under Review

Your claim has been submitted for review by one of our claims examiners.  Please allow 7-10 business days for review.  If we need additional documentation related to your claim, we will let you know.

 
Document Upload Details

Thank you for submitting the claim documents below.

Check #
Check Date
Amount
Payable To
Address
{{payment.CheckNumber}} Check # {{payment.CheckNumber}}
{{payment.CheckDate|date:'MM/dd/yyyy'}} Check Date {{payment.CheckDate|date:'MM/dd/yyyy'}}
{{payment.AmountPaid.Amount|currency}} Amount {{payment.AmountPaid.Amount|currency}}
{{payment.PayeeName}} Payable To {{payment.PayeeName}}
{{payment.Address}} Address {{payment.Address}}
 
Bank Name
Account
Payable To
Date
Amount
{{payment.BankName | lowercase}} Bank Name {{payment.BankName | lowercase}}
Ending in -{{payment.AccountNumber}} Account Ending in -{{payment.AccountNumber}}
{{payment.PayeeName}} Payable To {{payment.PayeeName}}
{{payment.PaymentDate|date:'MM/dd/yyyy'}} Date {{payment.PaymentDate|date:'MM/dd/yyyy'}}
{{payment.AmountPaid.Amount|currency}} Amount {{payment.AmountPaid.Amount|currency}}
 
Debit Card#
Name on Card
Payment Date
Amount
Funds Availability
Ending in - {{payment.CardNumber}} Debit Card# Ending in - {{payment.CardNumber}}
{{payment.PayeeName}} Name on Card {{payment.PayeeName}}
{{payment.PaymentDate|date:'MM/dd/yyyy'}} Payment Date {{payment.PaymentDate|date:'MM/dd/yyyy'}}
{{payment.AmountPaid.Amount|currency}} Amount {{payment.AmountPaid.Amount|currency}}
{{payment.FundsAvailable | lowercase}} Funds Availability {{payment.FundsAvailable | lowercase}}
 

Claim & Documentation Received - Under Review

Your claim has been submitted for review by one of our claims examiners.  Please allow 7-10 business days for review.  If we need additional documentation related to your claim, we will let you know.

 
Document Upload Details

Thank you for submitting the claim documents below.

Check #
Check Date
Amount
Payable To
Address
{{payment.CheckNumber}} Check # {{payment.CheckNumber}}
{{payment.CheckDate|date:'MM/dd/yyyy'}} Check Date {{payment.CheckDate|date:'MM/dd/yyyy'}}
{{payment.AmountPaid.Amount|currency}} Amount {{payment.AmountPaid.Amount|currency}}
{{payment.PayeeName}} Payable To {{payment.PayeeName}}
{{payment.Address}} Address {{payment.Address}}
 
Bank Name
Account
Payable To
Date
Amount
{{payment.BankName | lowercase}} Bank Name {{payment.BankName | lowercase}}
Ending in -{{payment.AccountNumber}} Account Ending in -{{payment.AccountNumber}}
{{payment.PayeeName}} Payable To {{payment.PayeeName}}
{{payment.PaymentDate|date:'MM/dd/yyyy'}} Date {{payment.PaymentDate|date:'MM/dd/yyyy'}}
{{payment.AmountPaid.Amount|currency}} Amount {{payment.AmountPaid.Amount|currency}}
 
Debit Card#
Name on Card
Payment Date
Amount
Funds Availability
Ending in - {{payment.CardNumber}} Debit Card# Ending in - {{payment.CardNumber}}
{{payment.PayeeName}} Name on Card {{payment.PayeeName}}
{{payment.PaymentDate|date:'MM/dd/yyyy'}} Payment Date {{payment.PaymentDate|date:'MM/dd/yyyy'}}
{{payment.AmountPaid.Amount|currency}} Amount {{payment.AmountPaid.Amount|currency}}
{{payment.FundsAvailable | lowercase}} Funds Availability {{payment.FundsAvailable | lowercase}}
 

In Process

Your claim is being reviewed by a claims examiner, and they have indicated that some additional information is needed for us to continue with your claim. Please review the list below and provide the necessary documents at your earliest convenience. If you have additional questions, please give us a call at 1-800-334-7525 and a member of our team will be happy to help you.

 

Check #
Check Date
Amount
Payable To
Address
{{payment.CheckNumber}} Check # {{payment.CheckNumber}}
{{payment.CheckDate|date:'MM/dd/yyyy'}} Check Date {{payment.CheckDate|date:'MM/dd/yyyy'}}
{{payment.AmountPaid.Amount|currency}} Amount {{payment.AmountPaid.Amount|currency}}
{{payment.PayeeName}} Payable To {{payment.PayeeName}}
{{payment.Address}} Address {{payment.Address}}
 
Bank Name
Account
Payable To
Date
Amount
{{payment.BankName | lowercase}} Bank Name {{payment.BankName | lowercase}}
Ending in -{{payment.AccountNumber}} Account Ending in -{{payment.AccountNumber}}
{{payment.PayeeName}} Payable To {{payment.PayeeName}}
{{payment.PaymentDate|date:'MM/dd/yyyy'}} Date {{payment.PaymentDate|date:'MM/dd/yyyy'}}
{{payment.AmountPaid.Amount|currency}} Amount {{payment.AmountPaid.Amount|currency}}
 
Debit Card#
Name on Card
Payment Date
Amount
Funds Availability
Ending in - {{payment.CardNumber}} Debit Card# Ending in - {{payment.CardNumber}}
{{payment.PayeeName}} Name on Card {{payment.PayeeName}}
{{payment.PaymentDate|date:'MM/dd/yyyy'}} Payment Date {{payment.PaymentDate|date:'MM/dd/yyyy'}}
{{payment.AmountPaid.Amount|currency}} Amount {{payment.AmountPaid.Amount|currency}}
{{payment.FundsAvailable | lowercase}} Funds Availability {{payment.FundsAvailable | lowercase}}
 

In Process

Your claim is in the last phase of review. Please allow five days for us to finalize your claim.

 

Check #
Check Date
Amount
Payable To
Address
{{payment.CheckNumber}} Check # {{payment.CheckNumber}}
{{payment.CheckDate|date:'MM/dd/yyyy'}} Check Date {{payment.CheckDate|date:'MM/dd/yyyy'}}
{{payment.AmountPaid.Amount|currency}} Amount {{payment.AmountPaid.Amount|currency}}
{{payment.PayeeName}} Payable To {{payment.PayeeName}}
{{payment.Address}} Address {{payment.Address}}
 
Bank Name
Account
Payable To
Date
Amount
{{payment.BankName | lowercase}} Bank Name {{payment.BankName | lowercase}}
Ending in -{{payment.AccountNumber}} Account Ending in -{{payment.AccountNumber}}
{{payment.PayeeName}} Payable To {{payment.PayeeName}}
{{payment.PaymentDate|date:'MM/dd/yyyy'}} Date {{payment.PaymentDate|date:'MM/dd/yyyy'}}
{{payment.AmountPaid.Amount|currency}} Amount {{payment.AmountPaid.Amount|currency}}
 
Debit Card#
Name on Card
Payment Date
Amount
Funds Availability
Ending in - {{payment.CardNumber}} Debit Card# Ending in - {{payment.CardNumber}}
{{payment.PayeeName}} Name on Card {{payment.PayeeName}}
{{payment.PaymentDate|date:'MM/dd/yyyy'}} Payment Date {{payment.PaymentDate|date:'MM/dd/yyyy'}}
{{payment.AmountPaid.Amount|currency}} Amount {{payment.AmountPaid.Amount|currency}}
{{payment.FundsAvailable | lowercase}} Funds Availability {{payment.FundsAvailable | lowercase}}
 

In Process

Your claim is in the last phase of review. Please allow five days for us to finalize your claim.

 

Check #
Check Date
Amount
Payable To
Address
{{payment.CheckNumber}} Check # {{payment.CheckNumber}}
{{payment.CheckDate|date:'MM/dd/yyyy'}} Check Date {{payment.CheckDate|date:'MM/dd/yyyy'}}
{{payment.AmountPaid.Amount|currency}} Amount {{payment.AmountPaid.Amount|currency}}
{{payment.PayeeName}} Payable To {{payment.PayeeName}}
{{payment.Address}} Address {{payment.Address}}
 
Bank Name
Account
Payable To
Date
Amount
{{payment.BankName | lowercase}} Bank Name {{payment.BankName | lowercase}}
Ending in -{{payment.AccountNumber}} Account Ending in -{{payment.AccountNumber}}
{{payment.PayeeName}} Payable To {{payment.PayeeName}}
{{payment.PaymentDate|date:'MM/dd/yyyy'}} Date {{payment.PaymentDate|date:'MM/dd/yyyy'}}
{{payment.AmountPaid.Amount|currency}} Amount {{payment.AmountPaid.Amount|currency}}
 
Debit Card#
Name on Card
Payment Date
Amount
Funds Availability
Ending in - {{payment.CardNumber}} Debit Card# Ending in - {{payment.CardNumber}}
{{payment.PayeeName}} Name on Card {{payment.PayeeName}}
{{payment.PaymentDate|date:'MM/dd/yyyy'}} Payment Date {{payment.PaymentDate|date:'MM/dd/yyyy'}}
{{payment.AmountPaid.Amount|currency}} Amount {{payment.AmountPaid.Amount|currency}}
{{payment.FundsAvailable | lowercase}} Funds Availability {{payment.FundsAvailable | lowercase}}
 

In Process

We have received your supporting documentation, and your claim is under review. Thank you for your patience.

 

Check #
Check Date
Amount
Payable To
Address
{{payment.CheckNumber}} Check # {{payment.CheckNumber}}
{{payment.CheckDate|date:'MM/dd/yyyy'}} Check Date {{payment.CheckDate|date:'MM/dd/yyyy'}}
{{payment.AmountPaid.Amount|currency}} Amount {{payment.AmountPaid.Amount|currency}}
{{payment.PayeeName}} Payable To {{payment.PayeeName}}
{{payment.Address}} Address {{payment.Address}}
 
Bank Name
Account
Payable To
Date
Amount
{{payment.BankName | lowercase}} Bank Name {{payment.BankName | lowercase}}
Ending in -{{payment.AccountNumber}} Account Ending in -{{payment.AccountNumber}}
{{payment.PayeeName}} Payable To {{payment.PayeeName}}
{{payment.PaymentDate|date:'MM/dd/yyyy'}} Date {{payment.PaymentDate|date:'MM/dd/yyyy'}}
{{payment.AmountPaid.Amount|currency}} Amount {{payment.AmountPaid.Amount|currency}}
 
Debit Card#
Name on Card
Payment Date
Amount
Funds Availability
Ending in - {{payment.CardNumber}} Debit Card# Ending in - {{payment.CardNumber}}
{{payment.PayeeName}} Name on Card {{payment.PayeeName}}
{{payment.PaymentDate|date:'MM/dd/yyyy'}} Payment Date {{payment.PaymentDate|date:'MM/dd/yyyy'}}
{{payment.AmountPaid.Amount|currency}} Amount {{payment.AmountPaid.Amount|currency}}
{{payment.FundsAvailable | lowercase}} Funds Availability {{payment.FundsAvailable | lowercase}}
 

In Process

Thank you for submitting your supporting documentation. Your claim is being reviewed by a claims examiner. If we need additional documentation, we will let you know. Otherwise, please allow 7-10 business days for review.

 

Check #
Check Date
Amount
Payable To
Address
{{payment.CheckNumber}} Check # {{payment.CheckNumber}}
{{payment.CheckDate|date:'MM/dd/yyyy'}} Check Date {{payment.CheckDate|date:'MM/dd/yyyy'}}
{{payment.AmountPaid.Amount|currency}} Amount {{payment.AmountPaid.Amount|currency}}
{{payment.PayeeName}} Payable To {{payment.PayeeName}}
{{payment.Address}} Address {{payment.Address}}
 
Bank Name
Account
Payable To
Date
Amount
{{payment.BankName | lowercase}} Bank Name {{payment.BankName | lowercase}}
Ending in -{{payment.AccountNumber}} Account Ending in -{{payment.AccountNumber}}
{{payment.PayeeName}} Payable To {{payment.PayeeName}}
{{payment.PaymentDate|date:'MM/dd/yyyy'}} Date {{payment.PaymentDate|date:'MM/dd/yyyy'}}
{{payment.AmountPaid.Amount|currency}} Amount {{payment.AmountPaid.Amount|currency}}
 
Debit Card#
Name on Card
Payment Date
Amount
Funds Availability
Ending in - {{payment.CardNumber}} Debit Card# Ending in - {{payment.CardNumber}}
{{payment.PayeeName}} Name on Card {{payment.PayeeName}}
{{payment.PaymentDate|date:'MM/dd/yyyy'}} Payment Date {{payment.PaymentDate|date:'MM/dd/yyyy'}}
{{payment.AmountPaid.Amount|currency}} Amount {{payment.AmountPaid.Amount|currency}}
{{payment.FundsAvailable | lowercase}} Funds Availability {{payment.FundsAvailable | lowercase}}
 

Complete

Good news! We are happy to let you know that your claim has been paid, and your payment is on the way.

 

Check #
Check Date
Amount
Payable To
Address
{{payment.CheckNumber}} Check # {{payment.CheckNumber}}
{{payment.CheckDate|date:'MM/dd/yyyy'}} Check Date {{payment.CheckDate|date:'MM/dd/yyyy'}}
{{payment.AmountPaid.Amount|currency}} Amount {{payment.AmountPaid.Amount|currency}}
{{payment.PayeeName}} Payable To {{payment.PayeeName}}
{{payment.Address}} Address {{payment.Address}}
 
Bank Name
Account
Payable To
Date
Amount
{{payment.BankName | lowercase}} Bank Name {{payment.BankName | lowercase}}
Ending in -{{payment.AccountNumber}} Account Ending in -{{payment.AccountNumber}}
{{payment.PayeeName}} Payable To {{payment.PayeeName}}
{{payment.PaymentDate|date:'MM/dd/yyyy'}} Date {{payment.PaymentDate|date:'MM/dd/yyyy'}}
{{payment.AmountPaid.Amount|currency}} Amount {{payment.AmountPaid.Amount|currency}}
 
Debit Card#
Name on Card
Payment Date
Amount
Funds Availability
Ending in - {{payment.CardNumber}} Debit Card# Ending in - {{payment.CardNumber}}
{{payment.PayeeName}} Name on Card {{payment.PayeeName}}
{{payment.PaymentDate|date:'MM/dd/yyyy'}} Payment Date {{payment.PaymentDate|date:'MM/dd/yyyy'}}
{{payment.AmountPaid.Amount|currency}} Amount {{payment.AmountPaid.Amount|currency}}
{{payment.FundsAvailable | lowercase}} Funds Availability {{payment.FundsAvailable | lowercase}}
 

What do I do if I receive both a refund or voucher from my travel/ticket supplier and a reimbursement from Allianz Partners?

If you receive additional reimbursement for this claim, please contact our Recovery Department and reference your claim number in your correspondence. Unless prohibited by law, you may be required to return to us any amount you receive that exceeds the total amount of your loss. We and your plan’s underwriter(s) each reserve our respective rights, remedies, and defenses under this plan and applicable law.

Recovery Department
PO Box 72032
Richmond, VA 23294
recovery@allianz.com   

If you would like additional assistance, please Contact Us.
If you would like to submit additional claim documents, please use the Required Documents Outstanding section below.

Complete

Good news! We are happy to let you know that your claim has been approved, and we are processing your payment.

What do I do if I receive both a refund or voucher from my travel/ticket supplier and a reimbursement from Allianz Partners?

If you receive additional reimbursement for this claim, please contact our Recovery Department and reference your claim number in your correspondence. Unless prohibited by law, you may be required to return to us any amount you receive that exceeds the total amount of your loss. We and your plan’s underwriter(s) each reserve our respective rights, remedies, and defenses under this plan and applicable law.

Recovery Department 
PO Box 72032
Richmond, VA 23294
recovery@allianz.com  

 

Check #
Check Date
Amount
Payable To
Address
{{payment.CheckNumber}} Check # {{payment.CheckNumber}}
{{payment.CheckDate|date:'MM/dd/yyyy'}} Check Date {{payment.CheckDate|date:'MM/dd/yyyy'}}
{{payment.AmountPaid.Amount|currency}} Amount {{payment.AmountPaid.Amount|currency}}
{{payment.PayeeName}} Payable To {{payment.PayeeName}}
{{payment.Address}} Address {{payment.Address}}
 
Bank Name
Account
Payable To
Date
Amount
{{payment.BankName | lowercase}} Bank Name {{payment.BankName | lowercase}}
Ending in -{{payment.AccountNumber}} Account Ending in -{{payment.AccountNumber}}
{{payment.PayeeName}} Payable To {{payment.PayeeName}}
{{payment.PaymentDate|date:'MM/dd/yyyy'}} Date {{payment.PaymentDate|date:'MM/dd/yyyy'}}
{{payment.AmountPaid.Amount|currency}} Amount {{payment.AmountPaid.Amount|currency}}
 
Debit Card#
Name on Card
Payment Date
Amount
Funds Availability
Ending in - {{payment.CardNumber}} Debit Card# Ending in - {{payment.CardNumber}}
{{payment.PayeeName}} Name on Card {{payment.PayeeName}}
{{payment.PaymentDate|date:'MM/dd/yyyy'}} Payment Date {{payment.PaymentDate|date:'MM/dd/yyyy'}}
{{payment.AmountPaid.Amount|currency}} Amount {{payment.AmountPaid.Amount|currency}}
{{payment.FundsAvailable | lowercase}} Funds Availability {{payment.FundsAvailable | lowercase}}
 

Complete

Our claims examiner has reviewed the details of your claim and unfortunately, we are unable to approve it based on the documentation we received. You will receive a letter or email that will provide additional details about the reason we could not approve your claim. If you have additional documentation that may affect this decision, please let us know or give us a call at 1-800-334-7525.

 

Check #
Check Date
Amount
Payable To
Address
{{payment.CheckNumber}} Check # {{payment.CheckNumber}}
{{payment.CheckDate|date:'MM/dd/yyyy'}} Check Date {{payment.CheckDate|date:'MM/dd/yyyy'}}
{{payment.AmountPaid.Amount|currency}} Amount {{payment.AmountPaid.Amount|currency}}
{{payment.PayeeName}} Payable To {{payment.PayeeName}}
{{payment.Address}} Address {{payment.Address}}
 
Bank Name
Account
Payable To
Date
Amount
{{payment.BankName | lowercase}} Bank Name {{payment.BankName | lowercase}}
Ending in -{{payment.AccountNumber}} Account Ending in -{{payment.AccountNumber}}
{{payment.PayeeName}} Payable To {{payment.PayeeName}}
{{payment.PaymentDate|date:'MM/dd/yyyy'}} Date {{payment.PaymentDate|date:'MM/dd/yyyy'}}
{{payment.AmountPaid.Amount|currency}} Amount {{payment.AmountPaid.Amount|currency}}
 
Debit Card#
Name on Card
Payment Date
Amount
Funds Availability
Ending in - {{payment.CardNumber}} Debit Card# Ending in - {{payment.CardNumber}}
{{payment.PayeeName}} Name on Card {{payment.PayeeName}}
{{payment.PaymentDate|date:'MM/dd/yyyy'}} Payment Date {{payment.PaymentDate|date:'MM/dd/yyyy'}}
{{payment.AmountPaid.Amount|currency}} Amount {{payment.AmountPaid.Amount|currency}}
{{payment.FundsAvailable | lowercase}} Funds Availability {{payment.FundsAvailable | lowercase}}
 

Thank you for notifying us of your loss. Our records indicate that we have not received all of the supporting documentation for your claim. Unfortunately, we cannot proceed with reviewing your claim until we receive the documents we need. If you have questions about what documents may be required for your claim type, please check the list below or give us a call at 1-800-334-7525. Please note: if we have not received documentation within 60 days of the first notice of loss, we will place your claim on hold. We are happy to re-open it at any time if you decide to proceed.

 

Check #
Check Date
Amount
Payable To
Address
{{payment.CheckNumber}} Check # {{payment.CheckNumber}}
{{payment.CheckDate|date:'MM/dd/yyyy'}} Check Date {{payment.CheckDate|date:'MM/dd/yyyy'}}
{{payment.AmountPaid.Amount|currency}} Amount {{payment.AmountPaid.Amount|currency}}
{{payment.PayeeName}} Payable To {{payment.PayeeName}}
{{payment.Address}} Address {{payment.Address}}
 
Bank Name
Account
Payable To
Date
Amount
{{payment.BankName | lowercase}} Bank Name {{payment.BankName | lowercase}}
Ending in -{{payment.AccountNumber}} Account Ending in -{{payment.AccountNumber}}
{{payment.PayeeName}} Payable To {{payment.PayeeName}}
{{payment.PaymentDate|date:'MM/dd/yyyy'}} Date {{payment.PaymentDate|date:'MM/dd/yyyy'}}
{{payment.AmountPaid.Amount|currency}} Amount {{payment.AmountPaid.Amount|currency}}
 
Debit Card#
Name on Card
Payment Date
Amount
Funds Availability
Ending in - {{payment.CardNumber}} Debit Card# Ending in - {{payment.CardNumber}}
{{payment.PayeeName}} Name on Card {{payment.PayeeName}}
{{payment.PaymentDate|date:'MM/dd/yyyy'}} Payment Date {{payment.PaymentDate|date:'MM/dd/yyyy'}}
{{payment.AmountPaid.Amount|currency}} Amount {{payment.AmountPaid.Amount|currency}}
{{payment.FundsAvailable | lowercase}} Funds Availability {{payment.FundsAvailable | lowercase}}
 

Claim & Documentation Received - Under Review

Thank you for submitting your supporting documentation. Your claim is being reviewed by a claims examiner. If we need additional documentation, we will let you know

 
Document Upload Details

Check #
Check Date
Amount
Payable To
Address
{{payment.CheckNumber}} Check # {{payment.CheckNumber}}
{{payment.CheckDate|date:'MM/dd/yyyy'}} Check Date {{payment.CheckDate|date:'MM/dd/yyyy'}}
{{payment.AmountPaid.Amount|currency}} Amount {{payment.AmountPaid.Amount|currency}}
{{payment.PayeeName}} Payable To {{payment.PayeeName}}
{{payment.Address}} Address {{payment.Address}}
 
Bank Name
Account
Payable To
Date
Amount
{{payment.BankName | lowercase}} Bank Name {{payment.BankName | lowercase}}
Ending in -{{payment.AccountNumber}} Account Ending in -{{payment.AccountNumber}}
{{payment.PayeeName}} Payable To {{payment.PayeeName}}
{{payment.PaymentDate|date:'MM/dd/yyyy'}} Date {{payment.PaymentDate|date:'MM/dd/yyyy'}}
{{payment.AmountPaid.Amount|currency}} Amount {{payment.AmountPaid.Amount|currency}}
 
Debit Card#
Name on Card
Payment Date
Amount
Funds Availability
Ending in - {{payment.CardNumber}} Debit Card# Ending in - {{payment.CardNumber}}
{{payment.PayeeName}} Name on Card {{payment.PayeeName}}
{{payment.PaymentDate|date:'MM/dd/yyyy'}} Payment Date {{payment.PaymentDate|date:'MM/dd/yyyy'}}
{{payment.AmountPaid.Amount|currency}} Amount {{payment.AmountPaid.Amount|currency}}
{{payment.FundsAvailable | lowercase}} Funds Availability {{payment.FundsAvailable | lowercase}}
 
 
Required Documents Received

Thank you for submitting the claim documents below.  If you’ve uploaded documents that you don’t see in the list, please check back later. They are processing through our system.

  • {{doc.DisplayName}}
+ - Previous File Upload(s)
  • Filename
  • Upload Date
  • {{file.DisplayName}}
  • {{file.UploadDate | myDate}}
Required Documents Outstanding

To complete the review of your claim, we still need the following outstanding documents.  If you have questions, please give us a call at 1-800-334-7525. 

Maximum size per document is 7MB.

Descriptions of Required Documents
{{doc.DisplayName}}
SELECT
  • {{upload.Name}}
The file may not be larger than {{MAX_FILE_SIZE}}
You may not upload more than {{MAX_FILES}} files
Invalid file type. Valid file extensions are as follows: {{FILE_EXT_DISPLAY}}
{{submitDocsError[bill.TypeId]}}
{{submitDocsSuccess[bill.TypeId]}}

No required documents outstanding

  • Filename
  • Status
  • {{file.DisplayName}}

  • Submitted {{file.UploadDate | myDate}} - Under Review

    • If you have additional documents you need to submit, you can do so below.

    Maximum size per documents is 7MB

    • {{selectedDocTypes[doc.BillTypeId].DisplayName || 'Select Document Type'}}
    ADD FILE
    {{uploadError}}
    The file may not be larger than {{MAX_FILE_SIZE}}
    You may not upload more than {{MAX_FILES}} files
    Invalid file type. Valid file extensions are as follows: {{FILE_EXT_DISPLAY}}
    {{doc.DisplayName}}
    • {{upload.Name}}
    {{submitDocsError[bill.TypeId]}}
    {{submitDocsSuccess[bill.TypeId]}}

    No required documents outstanding