Critical illness claims
How to make a claim
Use these forms if you have critical illness coverage through your employer/plan sponsor.
To submit a claim, follow these steps:
Complete a claimant statement
You’ll need to save and complete this form in full.
Request a completed employer statement
Your employer/plan sponsor needs to complete this form.
Request a completed physician’s report
Select the form for your condition and ask your doctor to complete it.
Submit your claim
Once you have these three forms completed, submit these to us via email.
You and your physician must fill in this form relating to treatment of bacterial meningitis. Submit this completed form as part of your claim.
A physician must fill in this form regarding loss of independence. Submit this completed form as part of a claim.
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.
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.
Your physician must fill in this form relating to treatment of dementia and Alzheimer's. Submit this completed form as part of your claim.
You and your physician will need to fill in this form relating to cancer treatment. Submit this completed form as part of your claim.
A physician will need to fill in this form relating to treatment for a coma. Submit this completed form as part of a claim.
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.
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.
You and your physician must fill in this form relating to coronary artery bypass surgery. Submit this completed form as part of a claim.
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.
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.
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.
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.
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.
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.
Your physician must fill in this form relating to aortic surgery. Submit this completed form as part of your claim.
You and your physician must fill in this form relating to treatment of aplastic anemia. Submit this completed form as part of your claim.
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.
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.
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.
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.
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.
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.
Use this form to describe the nature and extent of your accident or critical illness.
A physician must fill in this form regarding loss of independence. Submit this completed form as part of a claim.
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.
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.
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.
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.
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.
You and your physician must fill in this form relating to treatment of bacterial meningitis. Submit this completed form as part of your claim.
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.
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.
A physician will need to fill in this form relating to treatment for a coma. Submit this completed form as part of a claim.
You and your physician must fill in this form relating to coronary artery bypass surgery. Submit this completed form as part of a claim.
Your physician must fill in this form relating to treatment of dementia and Alzheimer's. Submit this completed form as part of your claim.
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.
You and your physician must fill in this form relating to treatment of aplastic anemia. Submit this completed form as part of your claim.
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.
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.
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.
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.
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.
You and your physician will need to fill in this form relating to cancer treatment. Submit this completed form as part of your claim.
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.
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.
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.
Your physician must fill in this form relating to aortic surgery. Submit this completed form as part of your claim.
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