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Accidental death or dismemberment claim forms

Have coverage through an advisor? You're in the right place.

If you have coverage through your employer or plan sponsor, use our workplace benefits insurance forms instead.

Start a claim

Use this form to make a claim for accidental death, dismemberment or specific loss.

To make a claim:

Step 1: Complete a claim form.

Download this form and print it, or fill it out in Adobe Reader XI or higher - Opens in a new window (not your browser) and save.

Step 2: Ask your doctor to complete a physician's report.

Download this form and print it, or fill it out in Adobe Reader XI or higher - Opens in a new window (not your browser) and save.

Step 3: Submit your claim.

When both parts are completed, please send a scanned copy to us via email at grouplifebenefits@canadalife.com or by fax at 1 2 0 4 9 4 6 8 7 8 3.

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