Critical illness claims
How to make a claim
If you have coverage through your employer or plan sponsor, use these forms to apply for critical illness benefits, either for you or your child.
Step 1: Complete a claimaint statement.
Download this form and fill it out in Adobe Reader XI or higher - Opens in a new window (not your browser) and save.
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Use this form to describe the nature and extent of your accident or critical illness.
Step 2: Ask your doctor to complete a report.
Choose the most appropriate form for your condition and ask your doctor to complete it.
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Use this form to describe the nature and extent of your accident or critical illness.
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You and your physician must fill in this form relating to treatment of aplastic anemia. Submit this completed form as part of your claim.
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You and your physician must fill in this form relating to treatment of bacterial meningitis. Submit this completed form as part of your claim.
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You and your physician will need to fill in this form relating to cancer treatment. Submit this completed form as part of your claim.
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You and your physician must fill in this form relating to coronary artery bypass surgery. Submit this completed form as part of a claim.
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You and your physician will need to fill in this form for treatment relating to hearing loss. Submit this completed form as part of a claim.
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Your physician must fill in this form relating to treatment of dementia and Alzheimer's. Submit this completed form as part of your claim.
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You and your physician must fill in this form for claims relating to a heart valve replacement. Submit this completed form as part of a claim.
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A physician must fill in this form regarding loss of independence. Submit this completed form as part of a claim.
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You and your physician will need to fill in this form for treatment relating to loss of speech. Submit this completed form as part of a claim.
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You and your physician must fill in this form for treatment relating to an organ transplant. Submit this completed form as part of a claim.
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You and your physician must fill in this form to confirm the diagnosis of multiple sclerosis. Submit this completed form as part of a claim.
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You and your physician must fill in this form to confirm the diagnosis of occupational HIV. Submit this completed form as part of a claim.
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You and your physician must fill in this form to confirm the onset of full or partial paralysis. Submit this completed form as part of a claim.
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You and your physician must fill in this form to confirm the onset of Parkinson's disease. Submit this completed form as part of a claim.
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You and your physician will need to fill in this form to confirm treatment for a stroke. Submit this completed form as part of a claim.
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Your physician must fill in this form relating to aortic surgery. Submit this completed form as part of your claim.
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You and your physician must fill in this form relating to treatment of a benign brain tumour. Submit this completed form as part of your claim.
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You and your physician will need to fill in this form relating to treatment of blindness. Submit this completed form as part of your claim.
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You and your physician will need to fill in this form for treatment relating to a heart attack. Submit this completed form as part of a claim.
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You and your physician must fill in this form for treatment relating to the loss of limbs. Submit this completed form as part of a claim.
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You and your physician must fill in this form to confirm the diagnosis of motor neuron disease. Submit this completed form as part of a claim.
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You and your physician will need to fill in this form for treatment relating to severe burns. Submit this completed form as part of a claim.
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A physician will need to fill in this form relating to treatment for a coma. Submit this completed form as part of a claim.
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You and your physician will need to fill in this form for treatment relating to kidney failure. Submit this completed form as part of a claim.
Step 3: Ask your employer or plan sponsor to complete an employer statement.
They should have this form already.
Step 4: Submit your claim.
Once you have these three forms completed, email them to us at groupciclaims@canadalife.com.