Claims Forms

For Allstate

Accident Claim Form

Accident Death & Dismemberment Claim Form

Allstate Authorization for Agents Form

Attending Physicians Statement for DI Claim

Authorization Form

Cancer & Specified Disease Claim Form

Critical Illness Claim Form

Disability Claim Form

Employers Statement for DI Claim

Hospital Indemnity Claim Form

Medical Provider List

MyBenefits Flyer - Submitting Allstate Claims Online

Outpatient Physicians Treatment Claim Form

Wellness Claim Form

Our Office

1640 S 70th St #200,

Lincoln, NE 68506

Contact Us

(402) 904-3026
sallberry@goueb.com

Office Hours

Mon-Fri: 8:30am – 5:00pm
Sat-Sun: By Appointment

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