Submitters shall complete the Document Submission Form according to the instructions on the Document Submission Form. Beneficiary change request.Submit this form to add or delete beneficiaries from a term life insurance plan. Browse commonly requested forms to find and download the one you need for various topics including pharmacy, enrollment, claims and more in California. Receive immediate acknowledgement of claims received and confirmation through your clearinghouse within two days as to if claims have been accepted or rejected. Find the insurance documents you need, including claims, tax, reimbursement and other health care forms. Insured's ID Number. (Patient's Medicare Health Insurance Claim Number - HICN). As soon as you have been notified of a work-related injury or occupational disease, please fill out this form and submit it to EMPLOYERS. You'll need to submit a separate intent to file form.