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Critical illness 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 these forms to apply for critical illness benefits for yourself or your child.

To make a claim:

Step 1: Complete a claim form.

Complete the form that applies for you, depending on whether you’re applying for benefits for yourself or a child.

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.

Critical illness - initial claim form - K883 (CL) PDF 222 kb

This form is to be completed by the insured in order to submit a claim for individual critical illness benefits.
Child critical illness - initial claim form - 186 (CL) PDF 311 kb

This form is to be completed by the insured in order to submit a claim for individual critical illness benefits for a child.

Step 2: Ask your doctor (or your child’s doctor) to complete a claim form.

Critical illness claim – Physician’s initial statement form – 70-0720 PDF 109 kb

This form is to be completed by the insured's attending physician in order to submit a claim for individual critical illness benefits.
Child critical illness claim – Physician’s initial statement form – 70-0734 PDF 103 kb

This form is to be completed by the child's attending physician in order to submit a claim for individual critical illness benefits for a child.

Step 3: Submit your claim.

When both forms are completed, please send scanned copies to us via email at lbclaims@canadalife.comOpens in a new window or by fax at 2 0 4 % 2 0 9 4 6 4 0 3 0.

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

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