December 31, 2020 | 10-K 44 Table of Contents CITIZENS, INC. Claims and Surrenders. Death claim and surrender benefits are our primary use of cash. As noted in the table below, claims and surrenders increased 13.4% from $106.8 million in 2019 to $121.1 million in 2020. BENEFITS AND EXPENSES Years ended December 31, (In thousands) 2020 2019 2018 Benefits and expenses: Insurance benefits paid or provided: Claims and surrenders $ 121,145 106,827  91,103  Increase in future policy benefit reserves 29,923 41,712  47,947  Policyholders' dividends 5,587 6,040  6,362  Total insurance benefits paid or provided 156,655 154,579  145,412  Commissions 32,069 34,222  34,962  Other general expenses 53,669 48,440  47,632  Capitalization of deferred policy acquisition costs (20,475) (22,255) (22,695) Amortization of deferred policy acquisition costs 27,439 28,268  34,235  Amortization of cost of insurance acquired 1,816 1,546  2,458  Total benefits and expenses $ 251,173 244,800  242,004 