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 |
|