Step 1: Completion of the claim forms
When an insured person has an eligible illness as defined in the critical illness policy, a claim should be submitted immediately1. A claim must be sent to us while the policy is in effect and within 1 year of the date the insured person has a covered critical illness.
Please contact the Individual Claims Services department directly for the appropriate critical illness claim forms. You can call Individual Claims Services toll free by dialing 1 800-800-4SUN (1 800 800-4786).
The person making the claim must complete the form and give us the information we need to assess the claim.
The form and information must be sent to this address:
Physicians may charge a fee to complete certain forms. The person making the claim is responsible for any fees for this information.
1Child plans: The first date a claim for Loss of independent existence may be made is the policy anniversary nearest the insured person's 18th birthday. If the insured person would have qualified for a Loss of independent existence before this date, you may still make a claim. However, you must submit the claim to us no later than the policy anniversary nearest the insured person's 19th birthday.
Note: No benefit is payable if the illness is cancer or benign brain tumour where signs or symptoms began in the first 90 days following the later of:
- the date the application for the policy was signed,
- the policy date,
- the underwriting decision date if included in the policy, or
- the most recent date this policy was put back into effect (reinstatement),
If this is the case, the client still has a responsibility to report the cancer or benign brain tumor. Form Responsibility to report cancer or benign brain tumour - E277
will need to be completed. You can print the form here or call the underwriting department toll free by dialing 1 800-800-4SUN (1 800 800-4786) for a copy of this form.
If this information is not provided within 6 months of the date of diagnosis, we have the right to deny any claim for cancer or benign brain tumor or any critical illness caused by any cancer or benign brain tumor or their treatment.
This form E277 will need to be forwarded to:
- Sun Life Assurance Company of Canada
Document Centre, Underwriting and Issue
227 King St S
PO Box 1601 Station Waterloo
Waterloo ON N2J 4C5
Note: No benefit will be payable for Parkinson's disease or specified atypical parkinsonian disorders if, within 1 year following the later of:
- the date the application for this policy was signed
- the underwriting decision date, but only if shown under the heading, Amendments to this policy
- the policy date, shown on the Policy summary, or
- the most recent date this policy was put back into effect (reinstatement) and/or
the insured person has any of the following:
- signs, symptoms or investigations that lead to a diagnosis of Parkinson's disease, a specified atypical parkinsonian disorder or any other type of parkinsonism, regardless of when the diagnosis is made, or
- a diagnosis of Parkinson's disease, a specified atypical parkinsonian disorder or any other type of parkinsonism.
If this is the case, the client still has a responsibility to notify us about Parkinson's disease or specified atypical parkinsonian disorders. Form Responsibility to report Parkinson's Disease and Specified Atypical Parkinsonian Disorders will need to be completed. You can print the form here or call the underwriting department toll free by dialing 1 800-800-4SUN (1 800 800-4786) for a copy of this form.
This form 4860-E will need to be forwarded to:
- Sun Life Assurance Company of Canada
Document Centre, Underwriting and Issue
227 King St S
PO Box 1601 Station Waterloo
Waterloo ON N2J 4C5
Sun Code 300B25
Step 2: Collection of medical information
Once we receive the forms, we will assess the insured person's eligibility for benefits. Written requests for additional medical information may be sent directly to the physician by Individual Claims Services as we may require additional medical information to assess the claim. If the policy was issued within the last five years, be sure to advise the client that these additional reports will be requested by Individual Claims Services to complete the assessment of the claim.
Step 3: Making the claims decision
Once we receive all information we require, Individual Claims Services assesses the information and makes its decision. We communicate the decision to the advisor. We send payment cheques to the advisor for delivery. If we deny a claim, we send a letter explaining the decision to the owner. If the owner and insured person are not the same person, we send two decline letters. We send one letter to the insured person fully explaining our decision. We send a separate letter to the owner confirming our denial of the claim but no medical information is given to the owner for privacy reasons.
To contact the Individual Claims Services department, you have the following options:
Critical illness occurring or diagnosed while in Canada
The person making a claim for a covered critical illness that occurs or is diagnosed in Canada must give us all information we need to assess the claim, including:
- proof that they have the right to receive a critical illness insurance benefit
- proof that the insured person suffered a critical illness while this policy was in effect
- a written diagnosis which describes the conditions and the cause of the illness, and
- the complete medical records of the insured person.
The written diagnosis must:
- include appropriate information to assess the illness, and
- be prepared and signed by a specialist licensed and practicing in Canada or by another physician acceptable to us.
A specialist is a licensed medical practitioner who has been trained in the specific area of medicine relevant to the critical illness for which a benefit is being claimed, and who has been certified by a specialty examining board. In the absence or unavailability of a specialist, a condition may be diagnosed by another qualified medical practitioner as approved by us.
Please refer to the sample policy pages for more details.
Critical illness occurring or diagnosed while outside of Canada
A claim can be made for a critical illness insurance benefit if a covered critical illness develops or is diagnosed while outside of Canada. The person making the claim will be required to provide us with all of the information described above. If the medical records of the insured person are not in French or English, the original records must be provided along with a translation2 of the records in either French or English. The person making the claim is responsible for any cost associated with providing the translation.
2The translator may not be the owner, any person insured under this policy, anyone entitled to make a claim under this policy, or any relative or business associate of these people.
Based on the medical records we require, we must be satisfied that the same diagnosis would have been made if the illness developed in Canada.
Tips for speeding up the claims process
Ensure the person making the claim completes all the information and fields on the claims forms and signs and dates the form.
The most common missing information is:
- Signatures: if the insured person is incapable of signing the claim form (incapacitated) ensure the CI claim form is signed by the Power of Attorney and submit the Power of Attorney papers with the signed claim form.
- Physician contact information: the full address, including postal code and phone number, of all doctors the insured person has consulted. Include all names of regular attending physicians and specialists.
If the claim is approved, the CII benefit is issued once the eligibility period has been satisfied subject to the definition outlined in the policy.
