Claim Form Instructions

Disability Claim Form Instructions - United States

You must complete Part I of the claim form. Part II must be completed by the licensed physician who is currently treating you and has deemed you disabled. To avoid delay, please verify that all sections of the claim form are fully completed including both yours and your doctor’s signature and all exact dates. Please write your account number on all attached documentation. If your loan was taken at a Household Finance or Beneficial Finance office, you may fax your claim and information to 1-866-952-0307. If your account or credit card is through Household Credit Services or HSBC Retail Services, you may fax your claim and information to 1-866-952-0307 or mail it to the address on your claim form.

Life Claim Form Instructions - United States

Please be sure to have both Part I & Part II completed. A death certificate indicating the cause and manner of death is required for every life claim. If the balance of the account is $15,000 or more, the death certificate must be an original or certified copy. A photocopy of the death certificate will only be acceptable for balances under $15,000. Please mail this to the address on your claim form.

Unemployment Claim Form Instructions - United States

Complete Part I of the claim form and have Part II completed by the state unemployment office, including documentation that you have registered with the state unemployment office within 30 days of your last day of work. If loss is due to generalized strike, unionized labor dispute or lockout, have your local union office complete Part III. If the state unemployment office refuses to complete your claim form, you can submit copies of all unemployment check stubs you received from the date of unemployment or a computer print out from the state unemployment office along with an employer statement verifying the reason and date for your separation from employment. To avoid delay, please verify that all sections of the claim form are fully completed properly and that your account number is written on all attached documentation. If your loan was taken at a Household Finance or Beneficial Finance office, you may fax your claim and information to 1-866-952-0307. If your account is a credit card through Household Credit Services or HSBC Retail Services, you may fax your claim and information to 1-866-952-0307 or mail it to the address shown on your claim form.

Property Claim Form Instructions - United States

If you are filing a loss of property claim, the claim form and supporting documents must be fully completed & returned to us. If available, please attach a copy of the Personal Property policy and the Identification of Security, also known as the Valuation of Personal Property. Attach supportive police, fire or other records verifying the incident causing the loss. Photographs may also help to expedite your claim. Include any purchase receipts and invoices. On repair items, you must attach the repair estimated or bill including the cause of damage on the items being repaired. Please do not discard your damage property without contacting us first.

To avoid delay, please verify that all sections of the claim form are fully completed including your signature and all exact dates. Please write your account number on all attached documentation. If your loan was taken at a Household Finance or Beneficial Finance office, you may fax your claim and information to 1-866-952-0307. If your account is a credit card through Household Credit Services or HSBC Retail Services, you may fax your claim and information to 1-866-952-0307 or mail it to the address on your claim form.

Family Leave Claim Form Instructions - United States

Please complete Section One and have your employer complete Section Two. To avoid any unnecessary delays, please verify that all sections of the claim form are fully completed including exact dates. You may fax your claim and information to 1-866-952-0307 or mail it to the address on your claim form.

Real Estate Loan Insurance Claim Form Instructions - United States

Complete the “Insured’s Statement of Loss” section including the signature and date.

You may bring your claim to your local loan office for assistance in completing the claim form. It is preferred to submit a copy of both the appraisal report and Real estate insurance policy for the loan under which you are submitting the claim. Attach a Fire Department report, if applicable and/or any newspaper clippings to verify the incident causing the loss. Including photographs may also expedite your claim. To avoid delay, verify that all sections of the claim form are completed properly and that your account number is written on all attached documentation. You may fax your claim and information to 1-866-952-0307 or mail it to the address on your claim form.

Term Life Claim Form Instructions - United States

We require the following information: completion of the claim form by the beneficiary of the policy, a certified death certificate, indicating the cause of death, a completed W-9 tax form and the original policy you received when the insurance was purchased.

If the original policy cannot be found, the Lost Policy Affidavit must be completed and sent to us along with the requested information. Please mail this information to: HSBC Insurance Services Claims Department, P.O. Box 911, New Castle, DE 19720.

Frequently Asked Questions (FAQs)

What is the waiting period for my policy?

Refer to your policy or terms and conditions or contact your Branch office for a copy of your policy.

What is the 1099 tax form for and why did I receive this form?

The Federal Govt. may require HSBC Insurance to report Involuntary Unemployment benefits and interest payments exceeding $600 in a calendar year.

I received a check, but it is endorsed to the Estate. How do I get it changed to my name?

Please request an affidavit to be completed and notarized.

Why is my monthly benefit amount different from my monthly payment?

You may have taken out an advance before the claim was approved or may have refinanced into new loan. Insurance only represents the terms of the old loan.

Is the Letter of Determination from the unemployment office sufficient proof of unemployment?

No, you must show either unemployment stubs or a computer printout of ALL benefits received. A link should go directly to the instruction section of the forms for all benefits (i.e., unemployment, disability, death)

I live in Canada and doctors do not use ICD Codes, what can they send?

The doctor can write out the actual diagnosis.

What is the average turn-around time for faxes or mail?

You should receive a response approximately 7-10 business days from the day your claim form or inquiry is received.

Can I send my Social Security Disability Award letter as proof of disability?

No. For disability benefits, we require either a fully completed claim or benefit activation form, or a signed statement from your physician on the physician’s letterhead.

If my claim is on autopay, when will I receive continuation forms so that my benefits don’t lapse?

We will send you a continuing claim form on the last auto-pay.

If I am trying to file a death claim for a family member, do I have to put my social security number on the claim form?

No, we only require the social security number of the deceased individual.

Can I fax the death certificate?

The administrator requires either the original or a certified copy of the death certificate.

After the claim is processed, how do I have the death certificate returned to me?

Please send a written request to the administrator, along with all pertinent documents, indicating the exact address where the death certificate should be sent.

Once they have exhausted, how do I show proof of my unemployment benefits?

You must submit a statement from the unemployment office or a certified employment agency indicating that you are still unemployed and registered for work.

Changes to Terms & Conditions

Notification of Change of Terms about AccountSecure and AccountSecure Plus Enrollments

The following change to your AccountSecure Plan is February 1, 2009 and after:

2. ACTIVATING BENEFITS:

You must be listed as an Accountholder prior to the Qualifying Event to be eligible for benefits. To activate benefits, an Eligible Person must experience a Qualifying Event and You must provide the required verification (See Section 3). You must notify the Administrator of the Qualifying Event by phone within 180 calendar days of the first day of the Qualifying Event. Then You must complete a Benefit Activation Form and provide the required verification to the Administrator within 90 calendar days of notification. Continuing Benefit Activation Forms and verification that the Qualifying Event is continuing must be provided within 90 days of notification, as required by the Administrator. If any requirements are not met, We will deny the initial Benefit Activation or the continuing Benefit Activation periods, as applicable. You will not be eligible for Benefit Activation again for a Qualifying Event if You elect to terminate Benefit Activation for that Qualifying Event. Your benefits do not begin until We activate them. Continue to manage Your Account according to Your Cardmember Agreement and Disclosure Statement until You receive Our response on Your request for Benefit Activation.

Notification of Change of Terms about Event Protector Enrollments

The following change to your Event Protector is February 1, 2009 and after:

1- APPLICATION FOR OR CONTINUATION OF DEBT CANCELLATION BENEFITS

In order to receive or continue receiving Benefits, the following must occur:

a)You must notify the Administrator of any Qualifying Event by phone or in writing not more than 180 calendar days after the first day of the Qualifying Event

Notification of Change of Terms about AccountSecure, AccountSecure Plus, Tap, Tap+, YP3, Value Guard, Account Shield, Account Saver, Event protector, Debt Can+:

The notification period for Loss of Life has been extended to 365 days. For Loss of Life You or Your estate have 365 days to notify the Administrator.

Common Terms & Definitions

24 MONTHS CRITICAL PERIOD:
The number of months the policy will consider benefits.

36 MONTHS CRITICAL PERIOD:
The number of months the policy will consider benefits.

AUTHORIZED USER:
The person who is authorized to make purchases on the line of credit.

AUTOMATIC MONTHLY PAYMENT:
The payment posts to the account automatically.

BENEFICIARY:
A person designated as the recipient of funds or benefits.

CLAIMANT:
Someone who claims a benefit.

DIAGNOSIS:
The identification by a medical provider of a condition, disease, or injury.

EFFECTIVE DATE:
The date on which coverage becomes enforced.

HIGHEST WAGE EARNER:
The person in the household who makes the highest wages.

PRE-EXISTING:
Treatment prior to the effective date of coverage or advance.

POLICY:
A written contract or certificate of insurance.

PRIOR LOAN TERMS:
The prior loan had insurance and the current loan is written consecutive with insurance.