Portable Accidental Death and Dismemberment (AD&D) claim forms
Have you added portable benefits coverage to your workplace plan? You’re in the right place.
Start a claim
Use these forms to make a claim through your Portable Benefits Accidental Death & Dismemberment (AD&D) and specific loss coverage.
Claim forms
Download this form and print it, or fill it out in Adobe Reader XI or higher (not your browser) and save.
Use this form to claim supplementary benefits through your portable benefits plan relating to Accidental Death & Dismemberment and specific loss.
Use this form to claim benefits through your Portable Benefits plan relating to accidental dismemberment and specific loss.
When you’ve completed your forms, you can submit them to us by email at grouplifebenefits@canadalife.com or fax to (204) 946-8783.