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Accidental dismemberment and specific loss

How to make a claim

If you have coverage through your employer or plan sponsor, use these forms to make an accidental death or dismemberment claim.

To make a claim, follow these steps:

 

Step 1: Complete a claim form.

Download the form and print it or fill it out in Adobe Reader XI or higher - Opens in a new window (not your browser) and save. You’ll need your employer to fill in some sections.

Step 2: If applicable, complete a claim form for any supplementary benefits.

Download the form and print it or fill it out in Adobe Reader XI or higher - Opens in a new window  (not your browser) and save. You’ll need your employer to fill in some sections.

Step 3: Request a completed physician’s report.

Ask your doctor to complete this form.

Step 4: Submit your claim.

You can email your completed forms to grouplifebenefits@canadalife.com or fax them to 204-946-8783.

In light of COVID-19, we ask that you do not mail these forms to us.

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