Central States Health & Life Co

Credit Insurance Claim Forms

A copy of your completed claim form can be faxed to CSO's claim department at: 800-325-9116

Claim Forms for Disability Benefits - select the state where the certificate was issued.

Claim Forms for Life Benefits - select the state where the certificate was issued.

Please complete both forms and mail to CSO Health & Life Co. of Omaha.

	The creditor should complete this form and mail along with an original certified death certificate.
	This form should be completed by the Personal Representative.
.	This form should be completed by the insured.
.	This form should be completed by the insured & physician.