Coverage bought online - AD&D claim forms
Bought Freedom to Choose™ health and dental insurance coverage directly through Canada Life? You’re in the right place.
If you have coverage through your employer or plan sponsor, use our workplace benefits insurance forms. If you have coverage through an advisor, use our personal insurance forms.
Start a claim
Use this form to make a claim for accidental death, dismemberment or specific loss.
To make a claim:
Step 1: Complete a claim form.
Download this form and print it, or fill it out in Adobe Reader XI or higher - Opens in a new window (not your browser) and save.
Use this form to apply for accidental dismemberment or specific loss benefits.
Step 2: Ask your doctor to complete a physician's report.
Download this form and print it, or fill it out in Adobe Reader XI or higher - Opens in a new window (not your browser) and save.
Use this form to provide information from your doctor about your accidental dismemberment or specific loss claim.
Step 3: Submit your claim.
When both parts are completed, please send a scanned copy to us via email at grouplifebenefits@canadalife.com or by fax at 1 2 0 4 9 4 6 8 7 8 3.
In light of COVID-19, we ask that you do not mail these forms to us.