Filing a Accidental
Dismemberment Claim
Filing a claim is never easy.
At the Club, we will guide you through
every step of the way.

Let us help you through these difficult times.

What do you need to know?

Plan pays a percentage of the AD&D coverage for the accidental loss of sight, hand, foot, speech and hearing

How Do I Get Started?

Please contact us to file a claim. The forms you will need to complete are the following:

  • Dismemberment Form For You to Fill Out
  • Dismemberment Form For Your Doctor to Fill Out

* The Club will complete the "Statement of Policyholder's Section"

Where to mail your claim forms?

City Employees Club of Los Angeles
Attention: Claims Dept.
311 S Spring Street. Suite 1300
Los Angeles, CA 90013

Benefits Payable

Depending on the permanent loss you have suffered, the policy pays 25% to 100% of the benefit amount.

100% 75% 50% 25%
Quadriplegia Paraplegia Hemiplegia Loss of Thumb & Index
Loss of two eyes   Loss of one eye  
Loss of two hands   Loss of one hand  
Loss of two feet   Loss of one foot  
Loss of speech & hearing   Loss of speech  
Loss of hand and foot or eye   Loss of hearing  

To File a Claim

Please contact our Claims Team


Most Frequently Asked Questions

How long does it take for a claim to be paid?

Once you mail the claim forms in, the United States Life Insurance Company will pay the Life benefit in two weeks.

           
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All artwork & logos are registered trademarks or trademarks of their respective companies. LACEA Insurance Services, Inc. ('City Employees Club of Los Angeles') is a licensed insurance agency offering insurance benefits to qualified Club members. The Club's CA DOI Lic. is #0B98000.