Assignment of Claim Proceeds

In some cases, a family may elect to assign its rights to a reimbursement check to a Funeral Home. Ohio Administrative Code (OAC) 4717-14-14 (F)

A Funeral Home or Funeral Director shall not apply to seek reimbursement from the fund.

This form is to be used for Assignment of the Proceeds of a Claim Filed With the Ohio Preneed Recovery Fund.

The following information will be needed by the Claimant:

1. Beneficiary Name (Deceased Beneficiary of Preneed Contract)
2. Claimant Name (Person Filing Claim Against Ohio Preneed Recovery Fund)
3. Funeral Home Name (Funeral Home Performing Funeral Services for Beneficiary)

This form will also have to be Notarized.

On behalf of the deceased Beneficiary who had a Preneed Funeral Contract that experienced financial loss as a result of failure, default, malfeasance, misfeasance, or insolvency, the Claimant has filed a claim on the Ohio Preneed Recovery Fund pursuant to Section 4717.41 of the Ohio Revised Code (the "Claim")

2. FUNERAL SERVICES: The Funeral Home is willing to provide funeral services for the deceased Beneficiary on the condition that Claimant assign to the Funeral Home the proceeds of the Claim as set forth below:

3. ASSIGNMENT OF CLAIM PROCEEDS: The Claimant hereby irrevocably assigns and transfers to the Funeral Home the proceeds of the Claim for the purpose for  funding, in whole or in part, the purchase of funeral goods and services from the Funeral Home for the Beneficiary. This instruction is for the purpose of disbursing reimbursement only. It shall not be construed as binding the Ohio Board of Embalmers and Funeral Directors to any agreement between Claimant and the Funeral Home.

4. PAYMENT OF PROCEEDS: Claimant is directing the Ohio Board of Embalmers and Funeral Directors to pay the proceeds of the Claim to the Funeral Home and the Funeral Home shall refund any excess funds remaining after payment of the funeral expenses to the Beneficiary's estate or the Claimant.

Click Here to access the Assignment of Claim Proceeds Form