Treating physician documents the accidental injury and treatment for a Family Heritage accident policy claim.
- Completed by
- Treating physician
- Issued by
- Family Heritage Life Insurance Company of America (Globe Life)
- Format
- Language
- English
Family Heritage C15FOB1ST: First Occurrence Statement
Family Heritage Life pays a lump-sum first-occurrence benefit when cancer is first diagnosed, and this one-page Section II is the physician's statement for that claim. The physician's office confirms when cancer was first diagnosed, whether the latest diagnosis came from a surgical biopsy, the cancer type and the first consultation date. A pathology report goes with it.
Who completes it
The policyholder completes Section I, the first occurrence claim form. The physician's office completes Section II, and the physician signs and dates it.
Submitting and payment
- How to submit it
- Return Section II with the policyholder's Section I and the pathology report to the Family Heritage claims department, through Globe Life's eClaims portal, by mail or by fax.
Good to know
- Question 2 asks whether the most recent cancer diagnosis was made from a surgical biopsy, with the CPT procedure codes used to diagnose it.
- Question 6 asks whether the office has records of the patient's past medical history; if not, list the family physician.
- The form also asks whether the patient has ever been diagnosed with AIDS or ARC, and if so, when.
- The office records the physician's name, specialty, address and phone at the top, along with the patient's name and policy number.
Get the official form
Download the current version from the source each time; forms change without notice.
First Occurrence Benefit Form – Section II: Physician's Statement
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.
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
Who completes Section II of the Family Heritage first occurrence form?
Section II is labeled to be completed by the physician's office. Staff can fill in the physician's details and answers to the six questions, but the physician signs and dates the statement. The policyholder completes Section I of the claim.
What documents go with a Family Heritage first occurrence cancer claim?
Send Section I from the policyholder, Section II from the physician's office and the pathology report. Section II asks for the date cancer was first diagnosed and the CPT codes used to diagnose it, which the pathology report supports.