What to do when a Midland National account holder dies
Report the death to Midland National's Life Claims at 1-800-733-2524
A death claim on a Midland National policy is filed through the Life Claims (1-800-733-2524). Because insurance proceeds pass directly to named beneficiaries, this process is separate from probate. The required documentation and timeline vary by policy type.
Death claim process
To file a claim after an account holder's death, here is what Midland National requires:
Filing a claim
- Life policy: Life Claims, 800-733-2524
- Annuity: Annuity Claims, 877-880-6367
- Sammons Retirement Solutions contract or account number beginning 71, 72, 73, 75 or 77: securities claims, 866-747-3421, option 3
- Midland National Pension certificate numbered 351000-399999: midlandnationalpension.com
- A form with whiteout is not accepted; correct the error, then initial and date the change
- When signing for a trust, estate or entity, add your title next to your signature (for example "Jane Doe, Trustee")
- Mail: Midland National Life Insurance Company, Life Division, P.O. Box 5973, Sioux Falls, SD 57117
- Overnight: Midland National Life Insurance Company, Life Division, One Sammons Plaza, Sioux Falls, SD 57193
- Fax: 877-841-6706
- Email: claims@sfgmembers.com
- Mail: Midland National Life Insurance Company, Annuity Division, P.O. Box 10385, Des Moines, IA 50306-0385
- Overnight: Midland National Life Insurance Company, Annuity Division, 8300 Mills Civic Parkway, West Des Moines, IA 50266
- Fax: 877-586-0249
Required Documents
- Death certificateWith cause and manner of death. A copy is acceptable if all claims total less than $500,000 and death occurred in the United States. Midland National may require an original; originals are not returned.
- Life proof of death claimant's statement (3864-1), on a life policyEach beneficiary completes their own. For ACH, a voided check with a pre-printed name or a signed bank letter on the bank's letterhead; starter checks and deposit slips are not accepted.
- Annuity proof of death claimant statement (14497Y), on an annuityFor ACH, a voided check with a pre-printed name or a signed bank letter; starter checks and deposit slips are not accepted. A lump sum with no payment method chosen is sent by check.
- Claimant Statement II, HIPAA form and Writing Agent Statement, on a contestable life claimAn original certified death certificate is required. Next of kin completes Claimant Statement II and the HIPAA form; the agent completes the Writing Agent Statement for Routine Contestable Claim Investigation.
- Part Two of the Claimant's Statement, a HIPAA authorization and the accident report, if the life policy pays an accidental death benefitCopies of the accident report or police incident report, newspaper clippings or other documentation of the accident, if available.
- Foreign death certificate, Foreign Death Questionnaire and Report of Death Abroad, for a death outside the United States, on a life policyAn original certified death certificate issued by the country of death. The Report of Death of American Citizen Abroad is issued by a U.S. embassy or consulate.
- Certification of trust form (7519), if a trust is the beneficiary of a life policyA notarized Generation-Skipping Transfer Tax Release (12973) is also required when the proceeds payable to the trust equal or exceed $250,000.
- Certification of Trust form (19306Y), if a trust is the beneficiary of an annuityA charitable trust uses the Certification of charitable Trust form (26742Y) instead.
- Court certificate of appointment and a Tax Identification number for the estate, if the estate is the beneficiaryThe executor or administrator completes the claimant statement. Midland National treats the decedent and the estate as separate taxable entities, so the estate needs its own TIN or EIN.
- Proof of the signer's authority, when an attorney-in-fact or a business signs for the beneficiaryAn attorney-in-fact sends the Certificate of power of attorney form (19656). A business, corporation or organization sends an authorized representative's original signature and a copy of the corporate resolution.
- Notarized Affidavit of surviving children (6506), when the beneficiary designation is surviving childrenCompleted by one surviving child.
- Name-change document, or a deceased beneficiary's death certificate, when the claimant's name differs from what the owner listed, or a beneficiary is deceasedFor example a name change document, marriage certificate or divorce decree.
- Investigating officer's details and written statement, if the cause of death was homicideThe officer's name, address and phone number, and a written statement on whether the investigation is ongoing and whether the beneficiaries have been excluded as potential suspects.
- IRS W-4P, and for a life annuity the life only disclaimer statement (8968Y), when electing annuity Settlement Option C, the annuity payment planA life annuity or a life annuity with period certain also needs a copy of a birth certificate or driver's license.
Forms Midland National issues12
- Life proof of death claimant's statement (combined 13945-2 and 3864-1)
Completed by each beneficiary. Available to download.1
- Annuity proof of death claimant statement (14497Y)
Completed by each beneficiary. Available to download.2
- Certification of Trust Agreement (7519), life policies
Available to download.3
- Certification of Trust agreement (19306Y), annuities
Available to download.4
- Certification of charitable trust (26742Y)
Available to download.2
- Release and Hold Harmless and Indemnification Agreement (12973), generation-skipping transfer
Completed by the trustee. Available to download. Must be notarized.5
- Certification of Power of Attorney (19656), life policies
Available to download.1
- Certification of POA (19656Y), annuities
Available to download.2
- Affidavit of Surviving Children (6506), life policies
Available to download.1
- Affidavit of surviving children (11734Y), annuities
Available to download.2
- Foreign Death Questionnaire (12974), life policies
Available to download.1
- Foreign death questionnaire (10774Y), annuities
Available to download.2
What happens to each kind of account2
- Annuity
Spousal continuance (Option A) is available only to the deceased owner's spouse who is the sole primary beneficiary. The spouse becomes the new owner of the contract and is entitled to all benefits available under it.6
Other options are a lump sum (B), an annuity payment plan (C), a non-qualified stretch over the beneficiary's life expectancy (D) or an inherited IRA (E). Moving proceeds to another company needs transfer paperwork and a letter of acceptance.6
For spousal continuance, the annuity claim forms page lists the spousal verification of identity (24443Y), the benefits rider spousal continuance form (23849Y) and the spousal continuance flyer (10460Y).2
- IRA
On a qualified annuity, section 7 of statement 14497Y covers the deceased's required minimum distribution for the year of death. If no option is selected, Midland National calculates and distributes it; the alternatives are naming a dollar amount or stating it need not come from this contract.6
Accounts handled elsewhere5
- Midland National Annuity Division
Annuity death benefit claims6
Phone: 1-877-880-6367
Fax: 1-877-586-0249
Hours: Monday-Thursday 7:30 AM-5:00 PM CT; Friday 7:30 AM-12:30 PM CT
Mailing address: Midland National Life Insurance Company, Annuity Division, P.O. Box 10385, Des Moines, IA 50306-0385 (overnight: 8300 Mills Civic Parkway, West Des Moines, IA 50266)
- Sammons Retirement Solutions securities claims
Securities claims, contract or account numbers beginning 71, 72, 73, 75 or 777
Phone: 1-866-747-3421 (option 3)
- Sammons Retirement Solutions client services (securities)
Client services for mutual funds and variable annuities (securities)8
Phone: 1-866-747-3421
Fax: 1-866-511-7038
Hours: Monday-Thursday 7:30 AM-5:00 PM CT; Friday 7:30 AM-3:00 PM CT
Mailing address: P.O. Box 9261, Des Moines, IA 50306-9261 (overnight: 8300 Mills Civic Pkwy, West Des Moines, IA 50266)
- Midland National Pension
Certificate numbers 351000-3999999
- Midland National Pension office
Pension or 1099 questions10
Phone: 1-833-496-0546
Email: pension@midlandnational.com
Fax: 1-701-433-6625
Mailing address: Midland National Life Insurance Company, 4225 38th Street South, Suite 201, Fargo, ND 58104
What Midland National's agreement and guidance say5
- How proceeds are paid
Life statement 3864-1 offers a lump sum by check, by ACH or into an Access Account (minimum $15,000), the Interest Option, the Installment Option and the Life Income Option. Elections are a full and final settlement once proceeds have been processed.11
A funeral home can be paid by assignment: the funeral home supplies the assignment form, each beneficiary signs one, an itemized copy of the funeral bill is attached, and a separate check is mailed directly to the funeral home.11
An annuity payment plan runs at least five years, and a monthly payment must go by ACH. For a qualified plan, 5 years minimum to 9 years maximum is available.6
Where a new annuity beneficiary designation is made, per capita applies if no election is made. A per stirpes designation needs a signed, dated list of the children with names, addresses, phone numbers, dates of birth and Social Security numbers.6
Any applicable interest on a life claim "is determined pursuant to state regulations and the terms of the Policy", and applicable rates are subject to change without prior notice.12
- Payment to a minor or incapacitated beneficiary
For a minor or incompetent beneficiary, the guardian of the estate completes the claimant statement with a court certificate of appointment. On a life policy with no legal guardianship, Midland National holds the proceeds at interest until the minor reaches the age of majority.11
- Indemnity a claimant may have to give
A spouse electing annuity spousal continuance represents being legally married to the deceased at the time of death, and agrees to indemnify and hold Midland National harmless from any negative consequences of the elections.6
The annuity claimant agrees to hold harmless and indemnify Midland National against liabilities and claims arising from its payment of the death claim proceeds to the beneficiary.6
- Contestability of a recent policy
A life claim is contestable when the death occurred within the first two years of the policy contract date, reinstatement, increase of coverage or change of class.11
A routine investigation is conducted on all contestable claims, and the processing timeframe depends on the investigation.12
- What it says about taxes
If state regulations require a state tax consent form, it is enclosed in the annuity claim packet. A beneficiary who is not a U.S. citizen or U.S. person sends IRS Form W-8BEN.6
Not in Midland National's published guidance2
- Interest rate on proceeds
- Downloadable state tax consent form
Sources12
- 1.Life Claim Forms
- 2.Annuity Claim Forms
- 3.Certification of Trust Agreement (7519), REV 3-23
- 4.Certification of Trust agreement (19306Y), REV 5-26
- 5.Release and Hold Harmless and Indemnification Agreement (12973), REV 8-22
- 6.Annuity proof of death claimant's statement (14496Y instructions and 14497Y statement), REV 2-26
- 7.Report a death (Sammons Retirement Solutions)
- 8.Contact us (Sammons Retirement Solutions)
- 9.Contact Us
- 10.Contact Us (Midland National Pension)
- 11.Instructions for completing proof of death claimant's statement (13945-2) and Life proof of death claimant's statement (3864-1), 13945-2 REV 6-25; 3864-1 REV 4-26
- 12.Life Claims Frequently Asked Questions (1037MM), 1-25
Midland National's processing goal is 10 calendar days from the final requirement; it may be extended if additional review or documentation is required.
Midland National's Life Claims can be reached by phone at 1-800-733-2524, email at claims@sfgmembers.com, and fax at 1-877-841-6706 for questions throughout the claims process.
Sources
Data sourced from Midland National primary sources (22 pages reviewed). How we research.
Midland National death claims support
Life Claims
Phone
Toll-free
Life claims, international
Annuity claims (different department)
Sammons Retirement Solutions securities claims
Midland National Pension, certificate numbers 351000-399999
Fax
Hours
Mailing address
Website
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