Claim Forms

The following forms allow your employees to submit group life, health or dental insurance claims to RBC Insurance.

Attending Physician Statement
Employees making claims must have their physician complete one of the following statements. When in doubt as to which statement is appropriate, use the General Statement.
Cancer - Form Number 83160
Cardiac - Form Number 83158
General - Form Number 83172
Musculoskeletal - Form Number 83162
Psychiatric - Form Number 83164
Rheumatology - Form Number 83156

Attending Physician Supplementary Statement 
If the employee is making a claim, the employee's physician must complete this supplementary statement.
Form Number: 14075

AWI/STD/ASO-STD Disability Claim Form 
If an employee is making a disability claim, they will need to provide us with a statement. The form also includes sections that will need to be filled out by the employer and the employee's physician.
Form Number: 14037

Claimant Supplementary Statement 
If the employee is making a claim, they must complete this statement.
Form Number: 14077

First Alert Employee Absence Form 
If the employee is making a claim, the employee and the employer must fill out the appropriate sections of this form.
Form Number: 14093B

Group Disability Claim - Employee Statement 
If the employee is making a claim, they must complete this statement.
Form Number: 82710

Group Disability Claim - Employer Statement 
The employer must complete this statement if an employee is making a claim.
Form Number: 82708

Group Life/Accidental Death Notice of Claim 
If the insured is deceased, the claimant, the employer and the deceased's physician must fill out specified sections of this form.
Form Number: 14073

Notice of Critical Illness Claim Form 
If you are making a claim for critical illness insurance benefits, you will need to fill out this form. It also includes a section to make a claim for return of premium on death if covered under the policy.
Form Number: 14003

Spouse Disability - Notice of Claim 
If your employee is making a spousal disability claim, they will need to provide us with a statement. The form also includes sections that will need to be filled out by the employer and the treating physician.
Form Number: 14080

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