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.
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Use this form to provide information from your doctor about your accidental dismemberment or specific loss claim.
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Use this form to apply for accidental dismemberment or specific loss benefits.
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