American Insurance Company
Mail to: ACE American Insurance Company Name of Group: P.O. Box 5124 Scranton, PA 18505-0556 Policy Number: 800-336-0627 – Telephone . 302-476-7857 – Fax. Diane.Basa@acegroup.com ACCIDENT AND SICKNESS CLAIM FORM Instructions: 1). You must have SECTION A fully completed by a designated official of the Policyholder. 2). SECTION B ................
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