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Claims - Request for Dependents' Benefits (Fatality)

Claims Division
Request for Dependents' Benefits (Fatality)

Ruby Tate, Claims Manager
Email: [email protected]
Phoenix: 800 W Washington St, Phoenix AZ 85007 - Phone: (602) 542-4661
Tucson: 2675 East Broadway, Tucson AZ 85716 - Phone: (520) 628-5181
FAX (use for either office): (602) 542-3373

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Request for Dependents' Benefits (Fatality)

Dependent Benefits Claim Form

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In case of an injury causing death, a claim for death benefits and burial expenses can be filed on behalf of the surviving spouse and/or surviving dependents.