Claim Forms

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

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

Disability Claim Form 
The employee will need to fill out this form if making a disability claim.
Form Number: 83730

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 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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