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American Income Life C-131: Accelerated Benefit APS

American Income Life, a Globe Life company, uses this two-page request when a policyholder with a terminal illness asks for an accelerated death benefit. The claimant completes Part A and signs a medical release, and the primary care physician completes Part B. Its key question asks whether a non-correctable condition will, with reasonable medical certainty, cause death within the next twelve months.

Who completes it

The claimant completes Part A, the claimant statement and release of medical information. The primary care physician completes Part B on page 2, covering diagnosis, onset, treatment and prognosis, then prints name and address, signs and dates.

Submitting and payment

How to submit it
The completed request goes to American Income Life by fax or mail using the details printed on the form, or the claimant can file online; the doctor completes Part B first.

Good to know

  • Part B asks when the terminal illness began, when the patient first consulted the physician for it, when and by whom the patient was told, and the likelihood of recovery.
  • The physician also records the recommended treatment and whether the patient has agreed to it, before answering whether the patient has a terminal illness.
  • A 24-month terminal illness version is posted for Illinois, Massachusetts, Pennsylvania and Washington; Globe Life's claims page lists both versions.
  • Globe Life's claims page says a Claimant Statement is required for all terminal illness claims, and claims are reviewed once all required documents arrive.

Get the official form

Download the current version from the source each time; forms change without notice.

Accelerated Benefit Request Form – Physician's Statement

Official pagePDF

Fill it with Vero

If your copy of the form is a fillable PDF, upload it once and Vero Documents fills it from the visit note and the chart, ready for you to review and sign. Download, print, or email the finished form, with the patient’s consent.

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How this list is checked

A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.

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Frequently asked questions

What does American Income Life's C-131 ask the physician to certify?

Question 9 asks whether, in the physician's professional opinion, the patient has a non-correctable medical condition that, with reasonable medical certainty, will result in death within the next twelve months. Question 8 separately asks whether the patient has a terminal illness.

Is there a 24-month version of the AIL accelerated benefit form?

Yes. American Income Life posts a 24-month terminal illness version for policies in Illinois, Massachusetts, Pennsylvania and Washington, alongside the standard 12-month version. Use the version that matches the patient's policy state.

Who completes Part B of form C-131?

Part B is headed for completion by the primary care physician. The physician enters the patient's name and policy number, the diagnosis and complications, and answers the questions on onset, notification, recovery, treatment and terminal illness, then signs with printed name, address and phone.