Health, dental and disability claim forms

 Extended health care benefits
This form is used for health care benefits, such as medical or paramedical expenses, drugs and vision care. Complete this form online, save it, print and sign it, and mail it to us along with your original receipts.
Important: Claims must be submitted no later than 12 months after expenses are incurred.

 Hospital allowance or daily indemnity
The Claimant's Statement is provided with 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 care
This form is used for dental claims. In most cases, your dentist will be able to submit claims automatically through an electronic data interchange (EDI) system.
If your dentist has EDI, you'll just need to provide your policy and ID numbers. Your dentist will electronically submit your claim to us, and we'll mail you or your dentist a reimbursement cheque for any eligible expenses.
If your dentist does not have EDI, please submit the completed and signed dental claim form provided to you by your dentist.

 Accidental fracture
The Claimant's Statement must be provided with the Attending Physician’s Statement. Both are required for any claims related to an accidental fracture.

 Critical illness
The Claimant's Statement, Attending Physician’s Statement and Medical Certificate are required for any claims 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 if the insured received out-patient treatments or home health care.

 Accidental loss of use or dismemberment
The Claimant's Statement and Attending Physician’s Statement are required for any claims related to accidental loss of use or accidental dismemberment.

 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.

 Loss of Autonomy Assessment
This form is required for any Long Term Care Insurance coverage.

 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.