Accidental death or dismemberment
How to make a claim
Use this form to make a claim for accidental death, dismemberment or specific loss.
To submit a claim:
- Print the appropriate form, and complete Part 1.
- Have your doctor (or your child’s doctor) fill out Part 2.
- When both parts are completed, please send a scanned copy to us via email at grouplifebenefits@canadalife.com or by fax at (204) 946-8783.
In light of COVID-19, we ask that you do not mail these forms to us.
Use this form to provide information from your doctor about your accidental dismemberment or specific loss claim.
Use this form to apply for accidental dismemberment or specific loss benefits.
Not the forms you're looking for? Go back to the find a form page.