Group Critical Illness Claim Forms

These forms are for group plan members with Group Critical Illness or Group Critical Illness Plus coverage. A Claimant’s Statement and a Confidential Physician’s Report must be completed for each claim.

These documents are in PDF format. To view and print them, you need Adobe Acrobat Reader Version 4.0 or higher, which you can download, at no cost, from the Adobe website.

• Claimant's Statement M6537

Confidential Physician's Report

Choose the Confidential Physician's Report form for the appropriate illness:

• Alzheimer's Disease M6540
• Aortic Surgery M6720
• Benign Brain Tumour M6542
• Blindness M6538
• Cancer M6545
• Coma M6547
• Coronary Artery Bypass Surgery M6546
• Deafness M6548
• Heart Attack (Myocardial Infarction) M6551
• Heart Valve Replacement M6722
• Kidney Failure M6549
• Loss of Independent Existence M6721
• Loss of Limbs M6543
• Loss of Speech M6550
• Major Burns M6544
• Major Organ Transplant M6552
• Motor Neuron Disease M6539
• Multiple Sclerosis M6553
• Occupational HIV M6541
• Paralysis M6554
• Parkinson's Disease M6556
• Stroke/CVA M6555