Forms

Please click on a form name below to download a pdf version. Then print it out, fill it out, and mail or fax it back to us. Please call (785) 228-1702 or (800) 715-1702 if you have questions regarding the forms.

Loyal American Forms

Cancer Screening Wellness Claim
Policy Change Request Form
Bank Authorization Form

Cancer Claim Forms

Instructions – Cancer Claim
Statement of Claim
Attending Physician’s Statement
Authorization Form
Personal Representative Form
Mileage Form

Accident Claim Forms

Instructions for Filing An Accident Claim
Accident Claim Form
Attending Physician’s Statement
Authorization Form

Application Form for Cancer Insurance/
Application Form for Accident Expense Coverage

Iowa
Kansas
Missouri
Nebraska

Philadelphia American Forms

Cancer Screening Reimbursement
Claim Form
Policy Change Form
Palic Bank Draft Form
Palic Claim Form
Palic Accident Claim Form
Authorization to Disclose
Mileage Reimbursement Form

More Information

Contact Us:
All American Associates
2942 SW Wanamaker Dr., Suite 150
Topeka, KS 66614
785-228-1702
800-715-1702
785-228-1720 [fax]

Send Us Email

Current News

Billing Changes Update

We are finding that a few groups have some errors on the new billings. Both All American Associates and Loyal American have worked... read more