Contact us about your injury & illness insurance

Complete this form to change the insurance agent or representative that services your policy.

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Complete this form if you have a wage loss replacement plan (WLRP) for disability insurance with your employer and your agreement with your employer has ceased (for example, your employment has terminated).

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Use this form to change your beneficiary for a critical illness insurance policy. The assigned beneficiary will receive any applicable refunds in the event of death.

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Use this form for a variety of requests, such as making a name or address change, assigning or releasing a collateral assignment, or cancelling a policy. You can also use this form to request a duplicate contract.

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Use this form to change the ownership on your disability insurance policy. (For example, if your employer or a business partner owns the policy on you and you change jobs, this form would be used to assign policy ownership to you.)

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Complete this form to reinstate a lapsed policy or to make changes to your existing policy coverage.

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Use this form to change your beneficiary for a disability policy. The assigned beneficiary will receive any applicable refunds in the event of death.

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Use this form to cancel your existing critical illness or disability insurance policy.

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If you would like to pay your premium by pre-authorized monthly debit, please complete this form and return it to our office.

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