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Health, dental and disability claim forms

Health, dental and disability claim forms

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Important
Claims filed for health care costs or disability benefits must be sent to the insurer within a certain period of time. This information is available in the Claimant's Statement. If the claim is not sent within the time specified, it could be refused by the insurer.

Health insurance

Extended health care

This form is used for the reimbursement of medical costs, fees for the services of a health professional, or fees for complementary health services.

Hospital allowance or daily indemnity

These forms include the Claimant's Statement and the Hospitalization Certificate. Both are required for any claim under one of the following benefits: hospitalization, hospital allowance, or daily indemnity. They may also be used to claim ambulance transportation expenses.

Important: The Hospitalization Certificate must be completed by an authorized agent.

Dental fees

This form is required only if the standardized form used by dentists was not automatically provided when the services were received.

Accidental fracture
These forms include the Claimant's Statement and the Attending Physician Statement. Both are required for any claim related to an accidental fracture.
Critical illness

These forms include the Claimant's Statement, Attending Physician Statement, and Medical Certificate, which are required for any claim filed for medical care costs related to a critical illness covered by the contract.

Important: The Medical Certificate must be completed by an authorized agent, to attest that the insured received out-patient treatments or home health care.

Accidental loss of use and dismemberment
These forms include the Claimant's Statement and Attending Physician Statement, which are required for any claim related to accidental loss of use or accidental dismemberment.

Disability insurance (Initial claim)

Claimant's guide - Disability insurance

This guide provides information and forms to help the claimant file the initial claim for disability benefits and/or waiver of premiums. The guide also answers frequently asked questions (FAQ).

Important: The claim must be submitted to the Insurer within 90 days of the onset of disability.

Overhead expense claim form - Business expense report

This form is required for overhead expenses benefit claims. All supporting documents must be provided for each business expense.

The overhead expenses claim being related to a sick leave, the claimant must first complete the claim forms for disability benefits. All forms are available in the Claimant's guide - Disability insurance. If the claim is not related to a wage-replacement benefit, no proof of income is required.

Please note that supporting documents may be requested regularly during a sick leave since expenses may change during a disability period.

Mortgage plan - Information on the creditor/loan

This form is required for any claim filed under the Mortgage Plan; proof of the last payments made to the creditor must be provided along with this form.

Since the claim is related to a leave of absence, the claimant must first complete the claim forms for disability benefits. All forms are available in the Claimant's guide - Disability insurance. If the claim is not related to a wage-replacement benefit, no proof of income is required.

In the case of a variable interest loan, payments to the creditor may vary. Supporting documentation may therefore be requested regularly during the disability period.

Please be advised that the direct deposit option is not authorized in the case of claims related to a mortgage loan or any other type of loan. Insurance benefits are paid directly to the creditor.

Forms to be completed during a disability period

Authorization(s) disability insurance
This authorization allows the insurer to obtain information that is necessary to continue the assessment of the claim. The form may be required from time to time since government departments and agencies require recently signed original authorizations.
Return to work notice
This form is required to confirm the date of return to work. If applicable, it may serve to reinstate the automatic benefit increase option on coverage suspended during the absence from work. A Medical Certificate specifying the date of return must be attached to this form.
Accident statement
This form may be required if the description of the accident given in the Claimant’s Statement form and included in the initial claim is considered incomplete.
Business expenses report

This report is necessary when a claim is filed under the overhead expenses benefit. Expense reports and supporting documents are regularly requested during a period of disability. Generally, this information is required every three months as we must ensure that current expenses are equal to the insured amount.

Employer's statement
If the insured person has more than one job, each employer must complete this form. The form may also be used if after an attempted return to work the insured person is disabled again. In this case, the employer must complete the form once again.
Attending physician's statement – additional report
If the disability has been extended, this form must be completed by the claimant’s attending physician or specialist. Updated clinical notes must be attached as well as the last medical reports in order to avoid any delays in the processing of the claim.
Request for payment by direct deposit

If this method of payment was not chosen on the initial claim, it is possible to request it at any time as long as the insurance file is active. The claimant can simply complete this form and attach a VOID cheque. However, this method of payment is not available for loan or mortgage claims as payments are made directly to the creditor.